Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis.

Abstract

BACKGROUND:

The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy.

AIM:

To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia.

METHODS:

We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms.

RESULTS:

A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement.

CONCLUSION:

In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.

• Authors: D L Francis, A Foxx-Orenstein, A S Arora, T C Smyrk, K Jensen, S L Nord, J A Alexander, Y Romero, D A Katzka
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 35 Issue 2 Pg. 300-7 (Jan 2012) ISSN: 1365-2036 [Electronic] England
• PMID: 22111863 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 Blackwell Publishing Ltd.

Chemical References

• Anti-Inflammatory Agents
• Anti-Ulcer Agents
• Budesonide
• Esomeprazole

Topics

• Adult
• Aged
• Anti-Inflammatory Agents (administration & dosage)
• Anti-Ulcer Agents (administration & dosage)
• Budesonide (administration & dosage)
• Eosinophilic Esophagitis (drug therapy, physiopathology)
• Esomeprazole (administration & dosage)
• Female
• Gastric Acidity Determination
• Humans
• Hydrogen-Ion Concentration
• Male
• Middle Aged
• Monitoring, Ambulatory
• Predictive Value of Tests
• Prospective Studies
• Severity of Illness Index
• Treatment Outcome