Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis

D. L. Francis, A. Foxx-Orenstein, A. S. Arora, Thomas Christopher Smyrk, K. Jensen, S. L. Nord, J. A. Alexander, Y. Romero, David A Katzka

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Abstract

Background: The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy. Aim To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia. Methods We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≤15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms. Results A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement. Conclusion In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.

Original languageEnglish (US)
Pages (from-to)300-307
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Volume35
Issue number2
DOIs
StatePublished - Jan 2012

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Eosinophilic Esophagitis
Ambulatory Monitoring
Esomeprazole
Budesonide
Eosinophilia
Therapeutics
Acids
Gastroesophageal Reflux
Eosinophils
Histology
Pharmacology

ASJC Scopus subject areas

  • Pharmacology (medical)

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Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis. / Francis, D. L.; Foxx-Orenstein, A.; Arora, A. S.; Smyrk, Thomas Christopher; Jensen, K.; Nord, S. L.; Alexander, J. A.; Romero, Y.; Katzka, David A.

In: Alimentary Pharmacology and Therapeutics, Vol. 35, No. 2, 01.2012, p. 300-307.

Research output: Contribution to journalArticle

Francis, D. L. ; Foxx-Orenstein, A. ; Arora, A. S. ; Smyrk, Thomas Christopher ; Jensen, K. ; Nord, S. L. ; Alexander, J. A. ; Romero, Y. ; Katzka, David A. / Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis. In: Alimentary Pharmacology and Therapeutics. 2012 ; Vol. 35, No. 2. pp. 300-307.
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abstract = "Background: The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy. Aim To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia. Methods We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≤15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms. Results A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61{\%}) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37{\%}) had positive pH studies and 32 (63{\%}) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61{\%}) had histological response and, of these eleven, five (46{\%}) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57{\%}) had histological and 11 (69{\%}) had symptomatic improvement. Conclusion In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.",
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AU - Francis, D. L.

AU - Foxx-Orenstein, A.

AU - Arora, A. S.

AU - Smyrk, Thomas Christopher

AU - Jensen, K.

AU - Nord, S. L.

AU - Alexander, J. A.

AU - Romero, Y.

AU - Katzka, David A

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N2 - Background: The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy. Aim To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia. Methods We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≤15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms. Results A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement. Conclusion In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.

AB - Background: The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy. Aim To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia. Methods We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≤15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms. Results A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement. Conclusion In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.

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