fluticasone and Heartburn

Non-dysphagia symptoms, such as heartburn and dyspepsia, are poorly characterized in adults with eosinophilic esophagitis (EoE). It is unclear if treatment improves these symptoms. The aim of this paper was to assess (i) heartburn and dyspepsia symptom severity in adult EoE patients using validated symptom measures; (ii) change in symptoms after treatment; and (iii) symptom association with endoscopic and histologic features. In a prospective cohort of adult EoE patients who were not responsive to proton pump inhibitor therapy, non-dysphagia symptoms were assessed with heartburn items from the validated GERD-HRQL (gastroesophageal reflux disease health-related quality of life) and SODA (severity of dyspepsia assessment) instruments. Subjects completed the questionnaires at baseline and after treatment. Association of baseline symptoms with endoscopic and histologic features, and before and after treatment with diet or topical steroids, was assessed. Eighty-six EoE patients (mean age 39 years, 57% male, 95% white) completed a baseline questionnaire and 62 completed the follow-up questionnaire. The mean baseline GERD-HRQL score was 4.5 ± 6.5 and the mean total SODA score was 41.0 ± 12.6. At baseline, there was a weak but significant correlation between peak eosinophils and the SODA score (r = 0.28; p = 0.03) and no association between heartburn and SODA scores and endoscopic or other histologic findings. After treatment, there was a decrease in GERD-HRQL heartburn (4.3 vs. 2.6; p = 0.04) and SODA (49.5 vs. 35.5; p = 0.04) scores in histologic responders, but not in nonresponders. In a prospective cohort of EoE patients, baseline eosinophils positively correlated with dyspepsia severity. Heartburn and dyspepsia symptoms improved after treatment in histologic responders.

Topics: Adult; Anti-Inflammatory Agents; Budesonide; Combined Modality Therapy; Diet Therapy; Dyspepsia; Eosinophilic Esophagitis; Esophagoscopy; Female; Fluticasone; Follow-Up Studies; Heartburn; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Severity of Illness Index; Treatment Outcome

We report a case of a 43 year old male patient, who was admitted with recurring esophageal bolus impactions. Since his childhood he has been complaining about dysphagia and was unable to swallow medication. He also complained about heartburn. The last esophageal bolus impaction was some weeks ago. After elimination of the bolus impaction with a rigid endoscope we found a high grade stenosis in the proximal esophagus that could not even be passed with a children's endoscope. An initial treatment of eosinophil esophagitis would be the therapy with a local corticoid for 6-9 month. In patients with typical rings or stenosis a dilation therapy might be necessary.

Topics: Administration, Oral; Adult; Androstadienes; Catheterization; Combined Modality Therapy; Deglutition Disorders; Diagnosis, Differential; Endoscopy, Digestive System; Eosinophilia; Esophageal Stenosis; Esophagitis; Fluticasone; Heartburn; Humans; Male; Prednisolone; Recurrence

Eosinophilic esophagitis is an inflammatory condition of the esophagus characterized by eosinophilic infiltration. It is a condition mainly affecting children; the adult form has only recently gained recognition as a distinct entity. The major symptom among adults with eosinophilic esophagitis is dysphagia. It is often misdiagnosed as gastroesophageal reflux disease because of the similarity in symptoms. An endoscopic biopsy is required to distinguish between the conditions. The cause of eosinophilic esophagitis is poorly understood, but food allergy has been implicated. Topical steroids are the most effective and convenient method for the treatment of eosinophilic esophagitis in adults. The long-term prognosis of eosinophilic esophagitis is uncertain; however, data suggests a benign course. We herein present two eosinophilic esophagitis cases that were the first to be diagnosed in our clinic.

Topics: Adult; Androstadienes; Anti-Inflammatory Agents; Biopsy; Deglutition Disorders; Eosinophilia; Esophagitis; Esophagoscopy; Esophagus; Female; Fluticasone; Heartburn; Humans; Male

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