Longitudinal Perspective on Managing Refractory Eosinophilic Esophagitis

The Journal of Allergy and Clinical Immunology. in Practice
John LeungWayne G Shreffler

Abstract

One half to one third of the patients with eosinophilic esophagitis (EoE) do not achieve histological remission on initial treatment. We wondered whether these treatment failure patients are a distinct clinical subset. To analyze EoE treatment outcomes in a predominantly pediatric population. We reviewed 100 serial EoE cases at Massachusetts General Hospital starting from 2007. We defined histological remission as peak esophageal eosinophil count of less than 10/hpf. Ninety-seven patients with EoE underwent initial treatments: 54 of 81 (67%) responded to dietary therapy, and 9 of 16 (56%) responded to topical glucocorticoids. Of the 34 who failed initial treatment, 24 underwent various second treatment regimens and 54% (13 of 24) responded. Eight of the remaining 11 who failed second treatment underwent additional treatments and 2 ultimately responded. The overall response rate by intent-to-treat analysis increased from 65% (63 of 97) with initial treatment to 78% (76 of 97) with rescue treatment, and further to 80% (78 of 97) with multiple treatments. On a per-protocol basis, the overall response rate was 93% (78 of 84); however, patients who failed the first 2 rounds of therapy had only a 20% response rate. Patients who respo...Continue Reading

References

Dec 20, 2005·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Chris A LiacourasJonathan E Markowitz
Jul 25, 2006·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Amir F KagalwallaB U K Li
May 1, 2012·The Journal of Allergy and Clinical Immunology·Carol J HendersonMarc E Rothenberg
Jun 30, 2012·The Journal of Allergy and Clinical Immunology·Jonathan M SpergelChris A Liacouras

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Citations

Jun 14, 2017·Digestive Diseases and Sciences·Cary C CottonEvan S Dellon
Feb 14, 2019·Gastroenterology Research and Practice·Erminia RidoloCristoforo Incorvaia
Mar 31, 2019·Digestive Diseases and Sciences·Cary C CottonEvan S Dellon
May 26, 2017·Nature Reviews. Gastroenterology & Hepatology·Evan S Dellon
Apr 28, 2020·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·Matthew A RankUNKNOWN Joint Task Force on Allergy-Immunology Practice Parameters collaborators
Mar 5, 2019·Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie·C VinitC Dupont

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