Hope for patients who failed eosinophilic esophagitis initial standard treatment


Published Online: September 2, 2015

Eosinophilic Esophagitis (EoE) is an allergic inflammatory disorder of the esophagus, often related to food allergy. In clinical practice, up to one half of the patients with EoE do not respond to standard medical or dietary treatment. Parents and patients often ask about the likelihood of responding to additional treatments, and whether there are any factors that predict response.  

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Leung et al  address these questions by reviewing the medical records of 100 serial EoE patients evaluated at Massachusetts General Hospital starting from January 2007. They analyzed their demographic data, clinical symptoms, endoscopic findings, skin test results, blood work, food triggers, as well as outcomes of initial and additional treatments.

They found that 97 EoE patients underwent initial treatments: 81 elected dietary therapy and 16 elected swallowed glucocorticoids. The initial response rate to dietary and swallowed glucocorticoids was 67% (54/81) and 56% (9/16) respectively. Of the 34 who failed initial treatment, 24 elected various second treatment regimens (3 swallowed glucocorticoids, 2 milk-free diet, 14 multiple food elimination diet, and 5 elemental diet), and overall, 54% (13/24) achieved histological remission. Eight of the remaining 11 who failed the second round of treatment underwent additional treatments and 2 ultimately achieved histological remission. For those patients who continued to pursue care at the same center, the overall response rate increased from 65% (63/97) to 93% (78/84) with multiple rounds of treatment.  Assuming the worst-case scenario for those who were lost to follow up, 78 of the 97 (80%) electing to begin treatment, achieved remission. However, patients who failed the first two rounds of therapy had only a 20% response rate. Patients who responded to initial treatment were found to have more symptoms and endoscopic abnormalities than those who failed to respond. No other distinguishing characteristics of treatment responders or failures were identified.

Based on these results, the authors advocate that patients who fail initial standard treatment (whether it is medical or dietary) should be offered additional individualized treatment, as more than half could ultimately respond.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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