SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

11/21/06

Oral fluticasone treatment in eosinophilic esophagitis

Summary
Background - Although several therapies of eosinophilic esophagitis (EE) have been proposed, no placebo-controlled trials of therapy in EE have been conducted.

Findings - Konikoff et al of the Cincinnati Children's Hospital Medical Center carried out a randomized, double blind, placebo-controlled trial of swallowed fluticasone propionate (FP), 880 mcg or placebo b.i.d. for 3 months in EE.

At the end of the FP treatment trial, there was a significant decrease in esophageal Eos frequency with complete remission of such inflammation in 50% of the FP-treated patients . In contrast, such a reduction of inflammation was observed in only 9% of placebo treated patients. Resolution of vomiting occurred more frequently with FP than with placebo treatment. FP-induced resolution of airway mucosal eosinophilia was seen more in younger, shorter, lighter patients. Mast cells and T cells in both the proximal and distal esophagus were also decreased following FP therapy.

Reference
Gastroenterology 2006;141:1381-1391

Editor's Comments
These findings suggest that a significant, though not uniform improvement in EE follows 3 month treatment with FP. One would want to be sure that there were no systemic adverse effects associated with the oral FP therapy.

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