montelukast and Esophagitis

Previously considered a rare condition, eosinophilic oesophagitis (EoE) has become increasingly recognized as an important cause of dysphagia and food impactions in adults. This is likely attributable to a combination of an increasing incidence of EoE and a growing awareness of the condition. EoE may occur in isolation or in conjunction with eosinophilic gastroenteritis. However, the burgeoning field is likely attributable to the variant that uniquely affects the oesophagus. Adults classically present with symptoms of dysphagia, food impactions, and heartburn. Typical endoscopic features include concentric mucosal rings, linear furrowing, white plaques or exudates and a narrow caliber oesophagus. In some cases, the endoscopic features may appear normal. For years, EoE went unrecognized because eosinophilic infiltration was accepted as a manifestation of reflux, which continues to be a confounding factor in some patients. Current consensus is that the diagnosis of EoE is established by 1) the presence of symptoms, especially dysphagia and food impactions in adults, 2) > or =15 eosinophils per high power field in oesophageal tissue, and 3) exclusion of other disorders with similar presentations such as GERD. Current understanding of EoE pathophysiology and natural history are limited but the entity has been increasingly linked to food allergies and aeroallergens. The main treatment options for EoE are proton pump inhibitors, dietary manipulation, and topical or oral glucocorticoids. This review highlights recent insights into EoE in adults although, clearly, much of the available data overlap with pediatrics and, occasionally, with eosinophilic gastroenteritis.

Topics: Acetates; Adrenal Cortex Hormones; Adult; Cyclopropanes; Dilatation; Eosinophils; Esophagitis; Esophagoscopy; Food Hypersensitivity; Humans; Immunologic Factors; Proton Pump Inhibitors; Quinolines; Sulfides

Eosinophilic esophagitis (EE) is a disease that is being recognized with increasing frequency. In children it is responsible for feeding disorders, vomiting, reflux symptoms and abdominal pain and in adults it causes dysphagia and esophageal food impactions. The diagnosis requires the histologic finding of > 20 eosinophils per high powered field in esophageal squamous mucosa. The most common treatment regimens in children and adults involve the ingestion of topical corticosteroids. Symptomatic relapse after one treatment course is common, and many patients require repeated courses of treatment. The long-term prognosis of EE is largely unknown.

Topics: Acetates; Adrenal Cortex Hormones; Allergens; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Catheterization; Cyclopropanes; Diet; Eosinophilia; Esophagitis; Food Hypersensitivity; Humans; Leukotriene Antagonists; Prognosis; Quinolines; Sulfides

Eosinophilic esophagitis (EE) is a relatively new, chronic, TH 2-type allergic inflammation of the esophagus. EE occurs more frequently in men. Allergic diseases such as asthma or atopic dermatitis are present in 50-70 % of patients or their relatives. In adults, the most common presenting symptom of EE is dysphagia, with or without food bolus impaction. Endoscopic findings of EE include mucosal furrows, corrugated or concentric rings or ridges in the esophagus ("feline esophagus"), with or without tiny whitish exudates. The diagnosis is confirmed by the observation of high counts of eosinophils in the esophageal epithelium (at least 24 /HPF). The cornerstones of medical therapy are either topical or systemic corticosteroids. Additional therapies included leukotriene receptor antagonists (montelukast) and IL-5 blockers (Mepolizumab). Complications of EE such as esophageal strictures should be carefully dilated using either bougies or a balloon. Currently it is still not known whether the late complications of EE can be prevented by the use of anti-inflammatory agents and this can only be demonstrated through further long-term follow-up studies.

Topics: Acetates; Adrenal Cortex Hormones; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bezoars; Catheterization; Cyclopropanes; Deglutition Disorders; Eosinophilia; Eosinophils; Esophagitis; Esophagoscopy; Humans; Leukocyte Count; Quinolines; Sulfides; Th2 Cells

Eosinophilic esophagitis is characterized by dense infiltration of the esophageal epithelium with eosinophils, typically accompanied by dysphagia. Effective therapies include the use of topical and systemic steroids as well as elimination diets. No previous reports have described the use of montelukast in the management of pediatric eosinophilic esophagitis. We retrospectively reviewed the charts of all patients with eosinophilic esophagitis followed in our pediatric center between 2000 and 2009. Those treated with montelukast were studied in detail. Study outcome was clinical response rate, defined by symptom (not histologic) improvement. Twenty-one patients with eosinophilic esophagitis were identified. Eight patients were maintained on montelukast (range 4-10 mg daily) after confirming the diagnosis of eosinophilic esophagitis histologically and failing to respond to a trial of proton pump inhibitor therapy. Three of eight patients had a clinical response (one had complete response and two with partial response) that could be attributed to montelukast. Four other patients responded clinically, but other therapies were concomitantly implemented. No side effects were reported with montelukast treatment with a mean follow-up duration of 32 months. Five patients had remained on montelukast therapy at the time of the final follow-up. Montelukast has minimal risk of adverse reactions compared with steroid therapy and may offer clinical relief in a small subset of children with eosinophilic esophagitis. Histologic response could not be verified in this study. Prospective studies, using higher montelukast doses, may potentially play a role and should be considered for future investigation.

Topics: Acetates; Adolescent; Child; Child, Preschool; Cyclopropanes; Eosinophilic Esophagitis; Esophagitis; Esophagus; Female; Follow-Up Studies; Humans; Leukotriene Antagonists; Male; Quinolines; Retrospective Studies; Sulfides; Treatment Outcome; Young Adult

Eosinophilic esophagitis in adults (EE) is a disease of unknown cause, characterized by symptoms such as reflux and dysphagia that traditionally do not respond to antacid treatment. It affects mostly young men with a strong personal or familial history of atopy asthma and allergies. We report three male patients aged 10, 14 and 15 years, all with symptoms of dysphagia, two of them with chest pain caused by spasm of the esophagus, with heterogeneous endoscopic findings which included from leucoplakia to stenosis that needed endoscopic dilatation. All of them had abnormal findings in immunity studies (prick test or IgE levels). They received treatment based on diet measures, acid suppression and leukotriene inhibitors, with satisfactory clinical, endoscopic and histological response. EE should be suspected in children and adults with esophageal symptoms and personal or family history of allergy and asthma.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Acetates; Adolescent; Child; Cyclopropanes; Eosinophilia; Esophagitis; Esophagoscopy; Humans; Lansoprazole; Male; Omeprazole; Quinolines; Sulfides

An otherwise healthy 20-year-old man was admitted to our hospital with obstruction of the oesophagus by a bolus after eating a chicken meal. These symptoms continued over the past 12 years and required multiple interventions at different hospitals. There was no history of any other previous illness and both the physical examination and routine laboratory tests were unremarkable.. Esophagogastroduodenoscopy (EGD) revealed segmental circular trachea-like constrictions of the esophagus and two stenoses at 35 cm and 40 cm. Histopathology of several biopsies favored the diagnosis of eosinophilic esophagitis.. After initial balloon dilatation and dilatation with a Savary bougie the patient was put on systemic steroids and montelukast (a leukotriene receptor antagonist). The symptoms subsequently disappeared.. Eosinophilic esophagitis, a unique form of esophageal inflammatory disease, consists of dense eosinophilic infiltration of the epithelium and is associated with various macroscopic findings, such as the rare but striking circular trachea-like constrictions, nodules, plaques and other forms of constriction of the esophagus. Several lines of evidence favor an allergic cause. The leading symptom is recurrent dysphagia after solid foods, sometimes accompanied by heart-burn. Medical treatment consists of topical or systemic administration of steroids and/or montelukast. A history of chronic dysphagia after eating solid food, combined with endoscopic findings atypical for reflux disease is highly suspicious of eosinophilic esophagitis in the differential diagnosis of gastroesophageal reflux disease in adults.

Topics: Acetates; Adult; Biopsy; Catheterization; Cyclopropanes; Deglutition Disorders; Diagnosis, Differential; Dilatation; Drug Therapy, Combination; Endoscopy, Digestive System; Eosinophilia; Esophageal Stenosis; Esophagitis; Esophagus; Glucocorticoids; Humans; Leukotriene Antagonists; Male; Prednisolone; Quinolines; Sulfides

Topics: Acetates; Adult; Androstadienes; Anti-Inflammatory Agents; Biopsy; Cyclopropanes; Diagnosis, Differential; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Eosinophilia; Esophagitis; Fluticasone; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides

Topics: Acetates; Child; Cyclopropanes; Deglutition Disorders; Diet; Eosinophilia; Esophagitis; Esophagus; Follow-Up Studies; Humans; Leukotriene Antagonists; Quinolines; Steroids; Sulfides; Treatment Outcome

To report a case of medication dispensing error by administration of similarly packaged drugs.. A 6-year-old East Indian boy with asthma was mistakenly given alendronate, a bisphosphonate, for 3 months instead of montelukast, a leukotriene-receptor antagonist. Symptoms of esophageal irritation developed and disappeared on discontinuation of alendronate.. Alendronate and montelukast have very similar packaging and are available in dosages that also can be similar for some patients. Alendronate caused symptoms of irritative gastritis in this child before the error was identified. This case report emphasizes one of the possible sources of medication dispensing errors: a mistaken identification due to similar packaging (confirmation bias). Manufacturers can help to prevent medication errors in many ways; in this case, more distinct packaging would have decreased the risk of error. A standard bar-coding scheme among manufacturers could lead to an important improvement in the safety of medication dispensation. Practitioners are also encouraged to report such errors to the United States Pharmacopoeia Medication Errors Reporting Program.. With increased awareness of medication errors, healthcare practitioners, manufacturers, and patients should take precautionary steps to prevent dispensing errors and their consequences.

Topics: Acetates; Alendronate; Asthma; Calcium Channel Blockers; Child; Cyclopropanes; Drug Packaging; Esophagitis; Humans; Leukotriene Antagonists; Male; Medication Errors; Quinolines; Sulfides

Eosinophilic oesophagitis is a rarely diagnosed condition involving eosinophil infiltration of the oesophageal mucosa and creating significant symptoms of dysphagia. Failure to diagnose this disorder relates to reluctance to biopsy an apparently normal oesophagus. This is essential for histological diagnosis. To date, treatment success has been achieved only with corticosteroids. We describe here the use of an eosinophil stabilising agent Montelukast for the symptomatic relief of these patients.. Twelve patients have been identified with this condition in our unit since 1995, after thorough investigation of their dysphagia. We commenced eight of these patients on the leukotriene receptor antagonist Montelukast to symptomatically improve their swallowing while avoiding the use of long term corticosteroids.. Many of these patients had been previously misdiagnosed, and therefore inappropriately and unsuccessfully treated for an extensive period prior to referral to our unit. All patients were unresponsive to acid suppression therapy alone but showed improvement in their swallowing on Montelukast. Six of eight reported complete subjective improvement, five patients remaining completely asymptomatic on a maintenance regimen.. Eosinophilic oesophagitis is a disease that is often misdiagnosed due to lack of awareness and reluctance of clinicians to biopsy an apparently normal oesophagus in dysphagic patients, and therefore obtain a histological diagnosis. Investigation of these patients adds further evidence to this condition being a separate pathological state from gastro-oesophageal reflux and eosinophilic enteritis. Montelukast has been found to be of significant help in the symptomatic control of these patients while avoiding long term corticosteroids use.

Topics: Acetates; Adult; Age of Onset; Biopsy; Cyclopropanes; Deglutition Disorders; Eosinophilia; Esophagitis; Esophagoscopy; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides; Treatment Outcome

Topics: Acetates; Cyclopropanes; Eosinophilia; Esophagitis; Humans; Leukotriene Antagonists; Quinolines; Sulfides