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The

American Journal

of

GASTROENTEROLOGY

7. Grudell AB, Alexander JA, Enders FB

et al.

Validation of the Mayo

Dysphagia Questionnaire. Dis Esophagus 2007;20:202–5.

8. Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal

esophagus. A quantitative measure of gastroesophageal reflux. Am J

Gastroenterol 1974;62:325–32.

9. Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal

pH monitoring composite scoring system. J Clin Gastroenterol 1986;8

(Suppl 1): 52–8.

10. Noel RJ, Putnam PE, Collins MH

et al.

Clinical and immunopathologic

effects of swallowed fluticasone for eosinophilic esophagitis. Clin Gastro-

enterol Hepatol 2004;2:568–75.

11. Konikoff MR, Noel RJ, Blanchard C

et al.

A randomized, double-blind,

placebo-controlled trial of fluticasone propionate for pediatric eosinophilic

esophagitis. Gastroenterology 2006;131:1381–91.

12. Schaefer ET, Fitzgerald JF, Molleston JP

et al.

Comparison of oral

prednisone and topical fluticasone in the treatment of eosinophilic

esophagitis: a randomized trial in children. Clin Gastroenterol Hepatol

2008;6:165–73.

13. Peterson KA, Thomas KL, Hilden K

et al.

Comparison of esomeprazole to

aerosolized, swallowed fluticasone for eosinophilic esophagitis. Dig Dis Sci

2010;55:1313–9.

14. Alexander JA, Jung KW , Arora AS

et al.

Swallowed fluticasone improves

histologic but not symptomatic response of adults with eosinophilic eso-

phagitis. Clin Gastroenterol Hepatol 2012;10:742–9.

15. Sperry SL, Shaheen NJ, Dellon ES. Toward uniformity in the

diagnosis of eosinophilic esophagitis (EoE): the effect of guidelines

on variability of diagnostic criteria for EoE. Am J Gastroenterol 2011;

106:824–32.

16. Straumann A, Conus S, Degen L

et al.

Budesonide is effective in adolescent

and adult patients with active eosinophilic esophagitis. Gastroenterology

2010;139:1526–37.

17. Straumann A, Conus S, Degen L

et al.

Long-term budesonide maintenance

treatment is partially effective for patients with eosinophilic esophagitis.

Clin Gastroenterol Hepatol 2011;9:400–9.

18. Aceves SS, Bastian JF, Newbury RO

et al.

Oral viscous budesonide: a poten-

tial new therapy for eosinophilic esophagitis in children. Am J Gastroen-

terol 2007;102:2271–9.

19. Dellon ES, Sheikh A, Speck O

et al.

Viscous Topical Is More Effective Than

Nebulized Steroid Therapy for Patients With Eosinophilic Esophagitis.

Gastroenterology 2012;143:321–4.

20. Spechler SJ, Genta RM, Souza RF. Thoughts on the complex relationship

between gastroesophageal reflux disease and eosinophilic esophagitis.

Am J Gastroenterol 2007;102:1301–6.

21. Cortes JR, Rivas MD, Molina-Infante J

et al.

Omeprazole inhibits IL-4 and

IL-13 signaling signal transducer and activator of transcription 6 activation

and reduces lung inflammation in murine asthma. J Allergy Clin Immunol

2009;124:607–10.

22. Zhang X CE, Hou X

et al.

In esophageal epithelial cell lines from patients

with eosinophilic esophagitis (EoE), omeprazole blocks the stimulated

secretion of eotaxin-3: a potential anti-inflammatory effect of omeprazole

in EoE that is independent of acid inhibition. Gastroenterology 2010;138

(suppl 1): S–122.

23. Dranove JE, Horn DS, Davis MA

et al.

Predictors of response to proton

pump inhibitor therapy among children with significant esophageal eosi-

nophilia. J Pediatr 2009;154:96–100.

24. Molina-Infante J, Ferrando-Lamana L, Ripoll C

et al.

Esophageal eosi-

nophilic infiltration responds to proton pump inhibition in most adults.

Clin Gastroenterol Hepatol 2011;9:110–7.

25. Pentiuk S, Putnam PE, Collins MH

et al.

Dissociation between symptoms

and histological severity in pediatric eosinophilic esophagitis. J Pediatr

Gastroenterol Nutr 2009;48:152–60.

26. Schoepfer AM, Gonsalves N, Bussmann C

et al.

Esophageal dilation in

eosinophilic esophagitis: effectiveness, safety, and impact on the underlying

inflammation. Am J Gastroenterol 2010;105:1062–70.

27. Straumann A, Spichtin HP , Grize L

et al.

Natural history of primary eosi-

nophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years.

Gastroenterology 2003;125:1660–9.

drafting of the manuscript, critical revision of the manuscript for

important intellectual content: Fouad J. Moawad; study concept and

design, study enrollment, acquisition of data, analysis and inter-

pretation of data, drafting of the manuscript, critical revision of the

manuscript for important intellectual content: Ganesh R. Veerappan;

data collection, verification and analysis, drafting of the manuscript:

Johnny A. Dias; histological analysis, drafting of the manuscript:

Thomas P. Baker; study concept and design, analysis and interpreta-

tion of data, drafting of the manuscript, critical revision of the

manuscript for important intellectual content: Corinne L.

Maydonovitch; study concept and design, drafting of the manuscript,

critical revision of the manuscript for important intellectual

content: Roy K.H. Wong.

Financial support:

None.

Potential competing interests

: None.

Disclaimer

The opinions are solely those of the authors and do not represent an

endorsement by the Department of Defense. This is US Government

work. There are no restrictions on its use.

Study Highlights

WHAT IS CURRENT KNOWLEDGE

3

Topical steroids are commonly used as first line treatment

for patients with a clinical presentation suggestive of EoE

and who have dense eosinophilic infiltration.

3

PPI therapy is often prescribed in esophageal eosinophilia

patients to help treat coexisting GERD and establish

diagnosis of EoE.

WHAT IS NEW HERE

3

Topical fluticasone had a lower than expected response rate

which may be dose and delivery related.

3

PPIs induce histological response in some patients with eso-

phageal eosinophilia regardless of the presence of GERD.

3

PPIs significantly improved clinical symptoms in patients

with esophageal eosinophilia even in the absence of GERD.

REFERENCES

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Eosinophilic esophagitis:

updated consensus recommendations for children and adults. J Allergy

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3. Furuta GT, Liacouras CA, Collins MH

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Eosinophilic esophagitis in

children and adults: a systematic review and consensus recommendations

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4. Ngo P , Furuta GT, Antonioli DA

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Eosinophils in the esophagus-

peptic or allergic eosinophilic esophagitis? Case series of three patients

with esophageal eosinophilia. Am J Gastroenterol 2006;101:1666–70.

5. Desai TK, Stecevic V , Chang CH

et al.

Association of eosinophilic inflammation

with esophageal food impaction in adults. Gastrointest Endosc 2005;61:795–801.

6. Hirano I. Eosinophilic esophagitis and gastroesophageal reflux disease:

there and back again. Clin Gastroenterol Hepatol 2011;9:99–101.

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