Swallowed Fluticasone Improves Histologic but Not Symptomatic Response of Adults With Eosinophilic Esophagitis

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• 作者：Jeffrey A. Alexander^鈦?/sup> ; ^{alexander.jeffrey14@mayo.edu} ; Kee Wook Jung^&Dagger ; ; Amindra S. Arora^鈦?/sup> ; Felicity Enders^&sect ; ; David A. Katzka^鈦?/sup> ; Gail M. Kephardt^鈭?/sup> ; Hirohito Kita^鈭?/sup> ; Lori A. Kryzer^鈦?/sup> ; Yvonne Romero^鈦?/sup> ; Thomas C. Smyrk^¶ ; ; Nicholas J. Talley^#
• 关键词：Esophagus ; EDN ; Steroid Treatment ; Dysphagic
• 刊名：Clinical Gastroenterology and Hepatology
• 出版年：2012
• 期刊代码：pca92_15423565
• 类别：med
• 出版时间：July, 2012
• 卷：10
• 期：7
• 页码：742-749.e1
• 文件大小：1362 K

摘要

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class="h4">Background & Aims

We evaluated the effect of aerosolized fluticasone therapy on symptomatic dysphagia and histologic eosinophilia in adults with eosinophilic esophagitis (EoE).

class="h4">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 渭g 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.

class="h4">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).

class="h4">Conclusions

Aerosolized, swallowed fluticasone leads to a histologic but not a symptomatic response in adults with EoE.