Control of inflammation appears to halt or slow the progression of fibrosis in EoE and provides a strong rationale for treatment of esophageal eosinophilia.
A recent research carried out by researchers from the Center for Esophageal Diseases and Swallowing at the University of North Carolina School of Medicine, in Chapel Hill USA demonstrates that controlling the inflammation is an important goal in patients with fibrostenotic changes of EoE, despite the use of esophageal dilation.
The investigators aimed to determine whether histologic response to topical steroid treatment decreased the likelihood and frequency of subsequent esophageal dilation. They revised retrospectively charts of patients with an incident diagnosis of EoE and considered those who had an initial esophageal dilation, received topical steroids, and had a subsequent endoscopy with biopsies. The number of dilations performed in each group was determined, and histologic responders (<15 eos/hpf) were compared to nonresponders.
A total of 55 patients met study eligibility criteria of baseline esophageal dilation, topical steroid treatment, and at least one follow-up endoscopy. Of these, 28 (51%) were nonresponders to topical steroids and 27 (49%) were responders. Both groups of patients did not differ by age, sex, or baseline symptoms. The patients who responded to therapy and normalized the esophageal mucosa required less than half the absolute number of dilations after treatment than those in whom the esophageal inflammation remained overtime (1.9 vs. 4.1 dilation procedures, respectively).
Despite undergoing significantly fewer dilations per patient, both groups of patients achieved a similar increase in esophageal diameter with dilation from the first to the last recorded procedure (4.9 vs. 5.0 mm, respectively for those without and with persistent eosinophilic inflammation)
In fact, 13 of the 27 patients with resolution of inflammation after treatment (48%) did not require any dilation during a follow-up period with a median of 19 months, compared with only 7 of 28 patients with persistent esophageal inflammation (25%).
Despite no data on patients achieving remission of eosinophilic inflammation with diets or after proton pump inhibitor (PPI) therapy were assessed in this research, we can speculate that results would not been different from those documented with topic steroids.
In conclusion, this retrospective cohort study found that in EoE patients requiring esophageal dilation at baseline, histologic response to topical steroids resulted in a need for less than half as many dilations to achieve the same increase in esophageal caliber
when compared to those without a histologic response to steroids.
Read the full paper at: https://www.ncbi.nlm.nih.gov/pubmed/29206905