| Treatment with high-dose proton pump inhibitors helps distinguish eosinophilic esophagitis from noneosinophilic esophagitis. | |
| | |
MedLine Citation:
|
PMID: 19633574 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Eosinophilic esophagitis (EE) is a clinical entity that is recognized increasingly in children. The treatment of EE has been debated since its identification as a clinical entity separate from reflux esophagitis. We hypothesize that the treatment with a high-dose proton pump inhibitor (HDPPI) helps differentiate EE from noneosinophilic esophagitis (NEE). PATIENTS AND METHODS: Retrospective review of 2221 patients who underwent esophagogastroduodenoscopy (EGD) with biopsies was undertaken. Sixty-nine patients had more than or equal to 15 eosinophils/high-power field (eos/HPF) in 1 or more esophageal levels. Of those, 36 were initially treated with HDPPI for 3 months followed by repeat EGD. Patients who demonstrated histologic response were classified as NEE. Patients with no histologic response were diagnosed as having EE and treated with HDPPI+swallowed fluticasone for 3 months followed by repeat EGD. RESULTS: Of the 36 patients, histologic response was seen in 14 (39%) after treatment with HDPPI; 95% confidence interval (0.23-0.54). Swallowed fluticasone was added to the treatment of the 22 patients who did not show histologic response to HDPPI alone. Of those, 15 patients underwent repeat endoscopies. Seven patients were lost to follow-up or did not have repeated EGDs. Histologic response was observed in 9 of 15 (60%) patients. Of the nonresponders (6 of 15), 5 of 6 (83%) self-reported noncompliance with the swallowed fluticasone. Patients with more than or equal to 15 eos/HPF at all 3 levels (25 of 36) were less likely to respond to HDPPI alone and more likely to be categorized as EE (18 of 25), P=or<0.043. Symptomatically, 28 of 36 patients reported resolution of symptoms after HDPPI therapy alone, P=or<0.0001, regardless of histology. Visual endoscopic findings during the first and second EGDs did not show any significance in differentiating EE from NEE, P=0.625 and P=0.2405, respectively. CONCLUSIONS: The study demonstrates that HDPPI can be used to help differentiate EE from NEE histologically. Moreover, patients with more than or equal to 15 eos/HPF at all 3 levels are less likely to respond to HDPPI than patients with more than or equal to 15 eos/HPF at fewer than 3 levels. Therefore, having more than or equal to 15 eos/HPF at 1 or 2 biopsy levels does not necessarily establish the diagnosis of EE. Symptomatic response to HDPPI does not correlate with histologic findings. Clinical management guided by EGD with biopsy helps distinguish patients with EE from those with NEE. |
| | |
Authors:
|
Wael N Sayej; Raza Patel; Robert D Baker; Eduardo Tron; Susan S Baker |
Related Documents
:
|
12167114 - Clinical characteristics and natural history of patients with low-grade reflux esophagi... 14751094 - Assessment of swallowing function in patients with head and neck cancer. 3501154 - Successful treatment of esophageal dysmotility and raynaud's phenomenon in systemic scl... 20686904 - A japanese case series of 12 patients with esophageal eosinophilia. 16606774 - Devic disease with brainstem lesions. 15123374 - Oral glutamine challenge and magnetic resonance spectroscopy in three patients with con... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Journal of pediatric gastroenterology and nutrition Volume: 49 ISSN: 1536-4801 ISO Abbreviation: J. Pediatr. Gastroenterol. Nutr. Publication Date: 2009 Oct |
Date Detail:
|
Created Date: 2009-12-29 Completed Date: 2010-05-14 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8211545 Medline TA: J Pediatr Gastroenterol Nutr Country: United States |
Other Details:
|
Languages: eng Pagination: 393-9 Citation Subset: IM |
Affiliation:
|
Digestive Diseases and Nutrition Center, Women and Children's Hospital of Buffalo, University at Buffalo, NY 14222, USA. wsayejmd@yahoo.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Androstadienes / pharmacology, therapeutic use Anti-Inflammatory Agents / pharmacology, therapeutic use Biopsy Child Child, Preschool Endoscopy, Digestive System Eosinophilia / drug therapy, pathology* Eosinophils / pathology* Esophagitis / drug therapy, immunology, pathology* Female Humans Male Proton Pump Inhibitors / pharmacology, therapeutic use* Retrospective Studies |
| Chemical | |
Reg. No./Substance:
|
0/Androstadienes; 0/Anti-Inflammatory Agents; 0/Proton Pump Inhibitors; 90566-53-3/fluticasone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Hepatic fibrosis scan for liver stiffness score measurement: a useful preendoscopic screening test f...
Next Document: Protein content and fortification of human milk influence gastroesophageal reflux in preterm infants...