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New treatment for eosinophilic oesophagitis? The first steps
Eosinophilic oesophagitis is an emerging disorder characterised by eosinophilic infiltration in the oesophageal mucosa often associated with dysphagia. Although treatment with corticosteroids often helps, some patients are resistant or suffer significant side effects. Such patients (n = 11) were the subject of this trial of meptolizumab, a monoclonal interleukin-5 (IL-5) antibody, which was given by intravenous infusion at 0 and 7 days, repeated after 8 weeks if needed. Patients were assessed by endoscopic biopsy and symptom questionnaire and all other treatments were discontinued. As expected since IL-5 is a major driver of eosinophilia, there was a marked fall in peripheral eosinophil counts (see fig) and a smaller though significant fall in oesophageal mucosal eosinophil count. Disappointingly there was no significant difference in improvement in dysphagia. However, markers of tissue remodelling, tenascin and TGFβ1 were reduced, suggesting that if given for a longer period the associated fibrosis might be reduced. The authors speculate that a more prolonged or perhaps combination treatment with corticosteroids would improve symptoms and since the treatment was well tolerated this is certainly possible. See page 21.
Mepolizumab caused a striking fall in blood eosinophils and a smaller but significant fall in oesophageal mucosa eosinophils (not shown) compared with placebo.
Alcohol and smoking synergistically increase the risk of oesophageal squamous cell carcinoma
While the incidences of oesophageal squamous cell carcinoma (OSCC) and gastric noncardia carcinoma (GNCA) are declining or stable in Europe and the USA, the incidence of oesophageal adenocarcinoma (OAC) and gastric cardia adenocarcinoma (GCA) are increasing. The current study used the prospective Netherlands …
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