Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Purpose: To describe the use of topical corticosteroids in the treatment of eosinophilic esophagitis.
Methods: We reviewed the charts and contacted adult patients diagnosed with eosinophilic esophagitis and treated with corticosteroid inhaler between September 1, 1999 and December 31, 2001. Diagnosis was based on the presence of solid-food dysphagia, endoscopic findings of a ringed or tapered distal esophagus, and the presence of greater than 20 eosinophils per high power field on esophageal biopsy. All patients received six weeks of treatment with fluticasone propionate 220 micrograms twice daily for six weeks at the time of diagnosis. Follow-up was performed by mail three years later, and information regarding further symptoms and treatment was collected using a questionnaire.
Results: Of the responses to date (10 patients), sixty percent of patients reported continued solid food dysphagia (breads and meats) at least once per week. All patients reported re-treatment with topical steroids at three year follow-up, some requiring multiple treatments. Despite treatment with topical steroids, seven patients required repeated endoscopic treatment for food impaction.
Conclusions: Eosinophilic esophagitis is an increasingly recognized cause of dysphagia and food impaction in adults. The diagnosis is suggested by subtle endoscopic findings including a ringed or furrowed esophagus, and confirmed with esophageal biopsies revealing dense eosinophilic infiltrates. Topical steroids are increasingly used for treatment. However, at three year follow-up, preliminary responses suggest that a majority of patients require repeated treatment. Furthermore, a number also experience food impaction requiring endoscopic therapy despite the topical steroid treatment. It seems over the long term, topical steroids may not modify the symptoms or need for endoscopic treatment of food impaction in eosinophilic esophagitis.