BACKGROUND: The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy. AIM: To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia. METHODS: We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms. RESULTS: A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement. CONCLUSION: In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.
BACKGROUND: The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy. AIM: To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia. METHODS: We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms. RESULTS: A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement. CONCLUSION: In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.
Authors: Swathi Eluri; Sara R Selitsky; Irina Perjar; Johnathan Hollyfield; Renee Betancourt; Cara Randall; Spencer Rusin; John T Woosley; Nicholas J Shaheen; Evan S Dellon Journal: Clin Gastroenterol Hepatol Date: 2018-09-10 Impact factor: 11.382
Authors: Evan S Dellon; Chris A Liacouras; Javier Molina-Infante; Glenn T Furuta; Jonathan M Spergel; Noam Zevit; Stuart J Spechler; Stephen E Attwood; Alex Straumann; Seema S Aceves; Jeffrey A Alexander; Dan Atkins; Nicoleta C Arva; Carine Blanchard; Peter A Bonis; Wendy M Book; Kelley E Capocelli; Mirna Chehade; Edaire Cheng; Margaret H Collins; Carla M Davis; Jorge A Dias; Carlo Di Lorenzo; Ranjan Dohil; Christophe Dupont; Gary W Falk; Cristina T Ferreira; Adam Fox; Nirmala P Gonsalves; Sandeep K Gupta; David A Katzka; Yoshikazu Kinoshita; Calies Menard-Katcher; Ellyn Kodroff; David C Metz; Stephan Miehlke; Amanda B Muir; Vincent A Mukkada; Simon Murch; Samuel Nurko; Yoshikazu Ohtsuka; Rok Orel; Alexandra Papadopoulou; Kathryn A Peterson; Hamish Philpott; Philip E Putnam; Joel E Richter; Rachel Rosen; Marc E Rothenberg; Alain Schoepfer; Melissa M Scott; Neil Shah; Javed Sheikh; Rhonda F Souza; Mary J Strobel; Nicholas J Talley; Michael F Vaezi; Yvan Vandenplas; Mario C Vieira; Marjorie M Walker; Joshua B Wechsler; Barry K Wershil; Ting Wen; Guang-Yu Yang; Ikuo Hirano; Albert J Bredenoord Journal: Gastroenterology Date: 2018-09-06 Impact factor: 22.682
Authors: Alfredo J Lucendo; Javier Molina-Infante; Ángel Arias; Ulrike von Arnim; Albert J Bredenoord; Christian Bussmann; Jorge Amil Dias; Mogens Bove; Jesús González-Cervera; Helen Larsson; Stephan Miehlke; Alexandra Papadopoulou; Joaquín Rodríguez-Sánchez; Alberto Ravelli; Jukka Ronkainen; Cecilio Santander; Alain M Schoepfer; Martin A Storr; Ingrid Terreehorst; Alex Straumann; Stephen E Attwood Journal: United European Gastroenterol J Date: 2017-01-23 Impact factor: 4.623