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Swallowed Fluticasone Improves Histologic…

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Dr. Alexander discusses his manuscript, “Swallowed Fluticasone Improves Histologic but Not Symptomatic Response of Adults With Eosinophilic Esophagitis .” To view the full-text version of this article go to

Hi i’m dr jeffrey alexander from the mayo clinic in rochester minnesota and i’m going to present this study published in in cgh on a randomized controlled trial of swallowed aerosolized fluticasone in the treatment of eosinophilic esophagitis this has been funded by a grant from the fitterman foundation and this slide shows the multiple co-authors cinephilic

Esophagitis is a disease we really didn’t start looking for in adult patients until after the year 2000 it’s a disease where patients develop eosinophils which is a type of white blood cell these eventually develop in their esophagus which can be associated with a symptom of solid food sticking they may also get some chest pain eosinophils are the allergic cells

You find them in the nose and people with seasonal allergies in the lungs and people with asthma and we recently discovered that they can involve the esophagus and lead to an increased frequency of this disease now we’ve actually shown in olmsted county that this instance of eosinophilic esophagitis is increased 30-fold over the past 15 years now some of that’s

Due to increased recognition of a disease we really didn’t didn’t know much about but a lot of it probably is increasing in true incidents as well swallow forticazone which is a medication used for asthma where we inhale it into the lung we use this in a swallowed fashion to treat eosinophilic esophagus is the most commonly used drug in this country however

There are no placebo-controlled trials of this drug showing it to be a benefit in adult patients the aims of our study were to evaluate the clinical efficacy of swallowed photigosome on patients symptoms as well as on the histology or the eosinophil counts in their esophagus we also want to look at the side effects or tolerability of the medication the study

Was set up that the patients would meet with our study coordinator they were then randomized in a double-blind fashion meaning the doctors didn’t know which drug they got and the patients didn’t know which drug they got 21 patients were treated with the active drug and 21 patients were treated with a similar dummy inhaler there were a fair number of dropouts

From the study in both groups now none of those dropouts were a result of side effects or a failure of the medication to work most of those were related to personal issues or primarily travel to rochester minnesota in the middle of the winter what we found here is shown in this slide the protocol response is those that actually completed the entire study the

Intention to treat analysis was quite similar histology meaning the eosinophils in the esophagus resolved in 68 percent of the patients treated with lotica zone and in none of the placebo patients which was a very strongly positive result and statistically significant however when we look at symptoms the result results weren’t so impressive 47 of the patients had

A complete symptom response with the drug but 40 of the placebo patients had a complete symptom response as well over the same time period when we look at the side effects that both the placebo and the drug were reasonably well tolerated there was no difference in the group overall with respect to side effects however 26 percent of the patients treated with the

Swallowed fluticasone did develop a oral yeast infection that was not statistically significant related to the small size of the study but certainly is something to be noted in summary we think fluticasone leads to a histological response of the eosinophils and the esophagus is quite impressive however this did not lead to a symptomatic response i.e did not lead

To resolution of their dysphasia the therapy was well tolerated but was associated with some oral candidiasis we speculate that the male dysphagia questionnaire may not be an accurate tool at assessing their symptom response we also speculate that possibly some patients may continue to have dysphagia symptoms despite resolution of their esophageal eosinophilia

Related to fibrosis with some loss of compliance or distensibility of their esophagus thank you for your time

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"Swallowed Fluticasone Improves Histologic…" By AmerGastroAssn