Patients with esophageal eosinophilia experienced greater clinical response and similar histological response when treated with esomeprazole compared with fluticasone in a recent study.
In a prospective, single blind controlled trial, researchers randomly assigned 42 patients with suspected eosinophilic esophagitis (EoE) to receive 440 mcg aerosolized fluticasone (FP, n=21) twice daily or 40 mg esomeprazole (ESO, n=21) once a day for 8 weeks. Four patients in each group had coexisting GERD.
Demographic data were collected and endoscopy was performed at baseline, and patients also underwent 24-hour pH/impedance monitoring. Participants responded to the 100-point Mayo dysphagia questionnaire (MDQ) before and after treatment, and they received endoscopy and esophageal biopsy at treatment completion.
Mean eosinophil counts decreased slightly following treatment (55.9 ± 25 vs. 39.2 ± 29.4, P=.102 for FP; 42.9 ± 18.9 vs. 30.5 ± 33.7, P=.174 for ESO). EoE resolved (less than 7 eosinophils/hpf) in 19% of the FP group and 33% of the ESO group (P=.484 for difference). No GERD patients in the FP group experienced resolution, while all GERD patients in the ESO group did (P=.029). No difference was observed between groups in the resolution rates of patients without existing GERD (24% of fluticasone recipients vs. 18% of the esomeprazole group, P=1).
Investigators noted a similar degree of improvement to histological markers, including intercellular edema, eosinophilic degranulation, distribution and microabscess, as well as endoscopic findings in the two groups. MDQ scores decreased after treatment in the esomeprazole group (19 ± 21 vs. 1.4 ± 4.5; P=.001), but not among fluticasone recipients (17 ± 18 vs. 12 ± 16; P=.162).
“Histological response between ESO and FP were similar in the treatment of esophageal eosinophilia, with neither drug having overwhelming treatment success,” the researchers concluded. “On the other hand, significant improvement in clinical symptoms was demonstrated with [proton pump inhibitor (PPI)] therapy. Further larger studies are needed to better define the optimal treatment for patients with esophageal eosinophilia and to better describe the subgroup and natural history of such patients who respond to PPI therapy.”