Efficacy of Combined Treatment on Eosinophilic Esophagitis in Adults: Case Study

Abstract

AIM: Eosinophilic esophagitis (EoE) is an increasing recognized disease involving eosinophil infiltration of the esophageal mucosa. Treatment with an anti-inflammatory agent or a proton pump inhibitor has been studied with clinical success, yet many patients relapse after completion of the treatment. We evaluated a combination regimen for symptomatic relief of patients with EoE.

METHODS: Eight patients from a single, adult gastroenterology unit with EoE were identified. Diagnosis was made by histological findings in addition to clinical symptoms. All the patients received 12-week treatment with combined oral pantoprazole 40 mg, montelukast 10 mg and swallowed fluticasone 880 micrograms daily. No maintenance medication was routinely used after the treatment.

RESULTS: Seven men and one woman with mean age at 35 years were evaluated. Seven patients presented with food impaction. Five patients had typical ringed-appearing esophagus. All patients had eosinophilic infiltration more than 15 per high power field histologically. Five patients (62.5%) had resolved or improved symptoms after the treatment. Two patients (25%) had recurrent but less severe symptoms 2 and 12 months after the treatment, respectively.

CONCLUSIONS: EoE affects predominantly middle-aged men and commonly presents with food impactions. The regimen of combined pantoprazole, montelukast and fluticasone might be effective in treating EoE and reducing recurrent symptoms. Additional studies, however, are warranted to further investigate the efficacy