Original ArticleEosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate
Section snippets
Patients
Twenty-six adult patients (aged ≥ 17 years) with a histologic diagnosis of EE were enrolled in this prospective study. Patients were excluded if systemic or inhaled corticosteroids had been used in the preceding 3 months. Histologic diagnosis required a mean intraepithelial eosinophil density >15 eosinophils/high power field (HPF) in the absence of gastric or duodenal eosinophil infiltrates. Esophageal biopsy specimens were taken in patients with a history of dysphagia or food-bolus
Patients
Between November 2002 and December 2003, 26 patients (18 men, 8 women) were recruited. Nineteen patients (13 men, 6 women) completed baseline investigation, treatment, and follow-up. Seven patients dropped out of the study before commencing treatment. The mean age of the pretreatment cohort was 36 years (range 17-65 years).
Clinical features
Baseline clinical characteristics of the pretreatment group are shown in Table 1. All 26 patients had a history of dysphagia for solid food. Seventeen had prior episodes of
Follow-up
All 19 treated patients (including 10 with significant reflux) had a dramatic improvement in symptoms with 4 weeks of treatment. Eleven became asymptomatic. The mean symptom score decreased from 5.42 to 0.68 (p < 0.0001) (Fig. 2). All patients had histologic improvement. Eighteen subjects had a significant decrease in the eosinophils/HPF count in both the proximal and the distal esophageal biopsy specimens, with complete resolution in 4. One patient had a rise in his proximal count (38.4-61
Discussion
EE is a distinct clinicopathologic entity that extends beyond childhood. There appears to be a lack of awareness of EE, its defining features (which can be subtle), and treatment options among adult gastroenterologists. Most series have been published within the last 5 years and raise the question: Is EE increasing in incidence or increasing in recognition? Recent pediatric population based and adult observational studies30, 31 support the concept of increasing incidence. Our local experience
Acknowledgments
The authors thank the gastroenterologists who contributed patients to the study and Linda Fletcher, PhD, who provided technical assistance and statistical analysis.
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