Author(s): Alexander JA, Jung KW, Arora AS, Enders F, Katzka DA,
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Abstract BACKGROUND & AIMS: We evaluated the effect of aerosolized fluticasone therapy on symptomatic dysphagia and histologic eosinophilia in adults with eosinophilic esophagitis (EoE). METHODS: We performed a double-blind, randomized, placebo-controlled trial of fluticasone in 42 adult patients with a new diagnosis of EoE (30 men; mean age, 37.5 y). Participants were assigned randomly to groups that swallowed 880 μg of aerosolized fluticasone twice daily (n = 21), or took a placebo inhaler twice daily (n = 15) for 6 weeks. End points of the study were symptomatic and histologic response. RESULTS: A complete histologic response (>90\% decrease in mean eosinophil count) was observed in 11 of 15 subjects who received 6 weeks of fluticasone (62\%), compared with none of the 15 subjects who received placebo (P < .001), based on intention-to-treat analysis; histologic responses were observed in 68\% of subjects who received fluticasone (13 of 19) compared with none of those who received placebo (0 of 15) by per-protocol analysis (P < .001). Intracellular staining for eosinophil-derived neurotoxin was reduced in 81\% of subjects who received fluticasone (13 of 16) compared with 8\% who received placebo (1 of 13) (P < .001). Dysphagia was reduced in 57\% of subjects who received fluticasone (12 of 21) compared with 33\% who received placebo (7 of 21) (P = .22) by intention-to-treat analysis; dysphagia was reduced in 63\% of patients who received fluticasone (12 of 19) and 47\% of those who received placebo (7 of 15) (P = .49) based on per-protocol analysis. Esophageal candidiasis developed in 26\% of subjects who received fluticasone (5 of 19), but in none of the subjects in the placebo group (P = .05). CONCLUSIONS: Aerosolized, swallowed fluticasone leads to a histologic but not a symptomatic response in adults with EoE. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
This article was published in Clin Gastroenterol Hepatol
and referenced in Journal of Hepatology and Gastrointestinal disorders