Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis
| Autor: | D L, Francis, A, Foxx-Orenstein, A S, Arora, T C, Smyrk, K, Jensen, S L, Nord, J A, Alexander, Y, Romero, D A, Katzka |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Anti-Inflammatory Agents Monitoring Ambulatory Esomeprazole Eosinophilic Esophagitis Gastric Acidity Determination Hydrogen-Ion Concentration Middle Aged Anti-Ulcer Agents Severity of Illness Index Treatment Outcome Predictive Value of Tests Humans Female Prospective Studies Budesonide Aged |
| Zdroj: | Alimentary pharmacologytherapeutics. 35(2) |
| ISSN: | 1365-2036 |
| Popis: | The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy.To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia.We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (5 eos/hpf) and symptoms.A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement.In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text