Leung John, Sia Twan, Miller Megan, Cunningham Evan, Buxton Claire, Huang Amy, Pak Daniel, Johnson Sarah, Dadlani Apaar, Epstein Taylor, Garrett Kendall, Nitschelm Rebecca, Tanaka Riki, White Thomas, Park Kristen
Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts.
Boston Specialists, Boston, Massachusetts.
Gastro Hep Adv. 2022 Apr 14;1(4):596-600. doi: 10.1016/j.gastha.2022.04.002. eCollection 2022.
Eosinophilic esophagitis (EoE) is an antigen-mediated inflammatory esophageal disease that is commonly treated with high-dose proton-pump inhibitors (PPIs), topical corticosteroids, or food elimination diet (FED) monotherapy. Combination treatment has not been well studied in the management of EoE. We aimed to determine if PPI and FED combination therapy was able to induce histologic remission in patients with EoE refractory to monotherapy.
We conducted a retrospective cohort study identifying patients with EoE that was refractory to PPI monotherapy and FED monotherapy but histologically responsive to PPI and FED combination therapy. We also identified symptom changes through chart review.
Out of 405 EoE patients, 12 patients were identified with EoE that was refractory to PPI monotherapy and FED monotherapy but histologically responsive to PPI and FED combination therapy. Out of 12 patients, 11 (91.67%) noted resolution of symptoms while on combination therapy. Comparative analysis of peak eosinophil counts showed that patients achieved a median of 4.5 eos/hpf (interquartile range [IQR], 2-6.5), which was significantly decreased compared to baseline (median, 45; IQR, 35.5-50; Wilcoxon signed-rank test, < .001), PPI monotherapy (median, 41; IQR, 26-50; Wilcoxon signed-rank test, < .001), and FED monotherapy (median, 45; IQR, 17-67.5; Wilcoxon signed-rank test, < .001).
Our work shows that patients with EoE refractory to PPI monotherapy and FED monotherapy can successfully achieve histologic remission and symptom benefit with PPI and FED combination therapy. Therefore, combination therapy should be considered a viable option for patients with EoE who fail treatment with first-line monotherapies.
嗜酸性粒细胞性食管炎（EoE）是一种抗原介导的炎症性食管疾病，通常采用高剂量质子泵抑制剂（PPI）、局部糖皮质激素或食物排除饮食（FED）单一疗法进行治疗。联合治疗在EoE的管理中尚未得到充分研究。我们旨在确定PPI与FED联合治疗是否能够使对单一疗法难治的EoE患者实现组织学缓解。
我们进行了一项回顾性队列研究，确定那些对PPI单一疗法和FED单一疗法难治但对PPI与FED联合治疗有组织学反应的EoE患者。我们还通过查阅病历确定症状变化。
在405例EoE患者中，有12例被确定为对PPI单一疗法和FED单一疗法难治，但对PPI与FED联合治疗有组织学反应。在这12例患者中，11例（91.67%）在联合治疗期间症状得到缓解。嗜酸性粒细胞峰值计数的比较分析显示，患者的嗜酸性粒细胞计数中位数达到4.5个/高倍视野（四分位间距[IQR]，2 - 6.5），与基线水平（中位数45；IQR，35.5 - 50；Wilcoxon符号秩检验，P <.001）、PPI单一疗法（中位数41；IQR，26 - 50；Wilcoxon符号秩检验，P <.001）以及FED单一疗法（中位数45；IQR，17 - 67.5；Wilcoxon符号秩检验，P <.001）相比均显著降低。
我们的研究表明，对PPI单一疗法和FED单一疗法难治的EoE患者通过PPI与FED联合治疗能够成功实现组织学缓解并获得症状改善。因此，对于一线单一疗法治疗失败的EoE患者，联合治疗应被视为一种可行的选择。
