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Eosinophilic oesophagitis: out of the frying pan into the fire?

▶ 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.

Eosinophilic oesophagitis is an increasingly recognised cause of chronic oesophageal symptoms, including retrosternal pain and recurrent dysphagia. The condition is resistant to proton pump inhibitor therapy, and therefore treatment consists of either corticosteroids or leukotriene antagonists, though high quality evidence for their efficacy is lacking.

Straumann et al report the results of a double-blind randomised placebo-controlled trial of budesonide suspension in this condition. Patients aged ≥14 years with endoscopically and histologically confirmed eosinophilic oesophagitis were randomised to active therapy or placebo, and upper gastrointestinal endoscopy and biopsy were performed at baseline and after 2 weeks of therapy. The primary outcome measure was reduction in the oesophageal eosinophil load (mean eosinophil number in 40 high power fields (HPF)). In addition, effect of treatment on disease activity was categorised as remission (<5 eosinophils per HPF), response (5 to 20 per HPF), or refractory (>20 per HPF). Patient-reported outcomes were also collected, according to frequency and intensity of dysphagia events, with a total symptom score from 0 to 9. A decrease of ≥3 from baseline was defined as a clinical response to therapy.

In total, 36 patients were randomised. The oesophageal eosinophil load decreased by 92% among the 18 patients randomised to budesonide, compared with …

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