fluticasone and Esophagitis--Peptic

Esophagitis is the end result of a variety of insults to epithelial homeostasis. Eosinophilic esophagitis is a manifestation of non-IgE-mediated food allergy that most commonly affects the esophagus of males who have other atopic phenomena. Reflux esophagitis reflects repeated exposure to acidic gastric contents because of failure of the normal protections afforded by the LES. Because certain histologic features can be present in either condition, endoscopic biopsy alone does not distinguish them. Their symptoms overlap, but the treatment options are very different, such that making a formal diagnosis by following consensus guidelines is essential. A treatment protocol designed to manage the inflammation by controlling the provocative factors (acid for GERD and food antigens for EoE) or suppressing the inflammation (ie, topical steroids for EoE) should result in normalization of the mucosa and resolution of symptoms. Eosinophilic esophagitis is a chronic condition that rarely remits spontaneously, so any therapeutic modality will need to be continued indefinitely.

Topics: Adolescent; Budesonide; Diet Therapy; Eosinophilic Esophagitis; Esophageal pH Monitoring; Esophagitis, Peptic; Fluticasone; Fundoplication; Gastroesophageal Reflux; Glucocorticoids; Histamine H2 Antagonists; Humans; Proton Pump Inhibitors

Eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD) have overlapping clinical, manometric, endoscopic and histopathologic features. The diagnosis of EE is nowadays based upon the presence of 15 or more eosinophils per high power field (eo/HPF) in esophageal biopsies. We report the cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies, both of which became asymptomatic on proton pump inhibitor (PPI) therapy. The first patient also achieved a histologic response, while EE remained in the other patient after effective PPI treatment, as shown by 24-h esophageal pH monitoring. Topical steroid therapy combined with PPI led to complete remission in this latter patient. GERD and EE may be undistinguishable, even by histology, so diagnosis of EE should only be established after a careful correlation of clinical, endoscopic and pathologic data obtained under vigorous acid suppression. These diagnostic difficulties are maximal when both diseases overlap. Limited data are available about this topic, and the interaction between EE and GERD is a matter of debate. In this setting, upper-mid esophagus step biopsies and esophageal pH monitoring of patients on PPI therapy are pivotal to evaluate the role of each disease. A PPI trial is mandatory in patients with a histopathologic diagnosis of EE; in those unresponsive to PPI treatment, EE should be suggested. However, a clinical response to PPI may not rule out quiescent EE, as shown in this report.

Topics: Adult; Androstadienes; Anti-Inflammatory Agents; Eosinophilia; Esophagitis; Esophagitis, Peptic; Esophagus; Fluticasone; Humans; Male; Proton Pump Inhibitors

Esophageal lichen planus (ELP) is a rare condition with unknown prevalence that can sometimes be underestimated due to the subtle and nonspecific findings of diagnostic workup. Oral lesions rarely extend to the esophageal mucosa, but when they do, the most frequent symptoms are dysphagia and odynophagia. There is often a significant delay in diagnosis and inadequate treatment. We report the case of a 59-year-old woman diagnosed with ELP, successfully treated with rituximab, a chimeric monoclonal antibody that depletes CD20+B cells. To our knowledge, this is only the second report of this treatment in ELP.

Topics: Alopecia; Androstadienes; Anti-Inflammatory Agents; Antibodies, Monoclonal, Murine-Derived; Atrophy; Esophageal Diseases; Esophageal Stenosis; Esophagitis, Peptic; Esophagus; Female; Fluticasone; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Middle Aged; Mucous Membrane; Prednisone; Proton Pump Inhibitors; Rituximab; Salvage Therapy; T-Lymphocyte Subsets; Vulvar Lichen Sclerosus

Topics: Administration, Inhalation; Administration, Oral; Aged; Androstadienes; Esophageal Stenosis; Esophagitis, Peptic; Female; Fluticasone; Humans; Male; Middle Aged; Nebulizers and Vaporizers

Topics: Androstadienes; Antacids; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Antirheumatic Agents; Aspirin; Barrett Esophagus; Child; Cross-Over Studies; Cyclooxygenase Inhibitors; Deglutition Disorders; Diagnosis, Differential; Double-Blind Method; Dyspepsia; Endoscopy; Eosinophilia; Esophagitis; Esophagitis, Peptic; Family Practice; Fluticasone; Gastroesophageal Reflux; Heartburn; Helicobacter Infections; Helicobacter pylori; Humans; Incidence; Middle Aged; Omeprazole; Prednisone; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Recurrence; Surveys and Questionnaires; Time Factors