Efficacy of Combined Treatment on Eosinophilic Esophagitis in Adults: Case Study

AIM: Eosinophilic esophagitis (EoE) is an increasing recognizeddisease involving eosinophil infiltration of the esophageal mucosa.Treatment with an anti-inflammatory agent or a proton pump inhibitorhas been studied with clinical success, yet many patients relapse aftercompletion of the treatment. We evaluated a combination regimen forsymptomatic relief of patients with EoE.METHODS: Eight patients from a single, adult gastroenterologyunit with EoE were identified. Diagnosis was made by histologicalfindings in addition to clinical symptoms. All the patients received12-week treatment with combined oral pantoprazole 40 mg,montelukast 10 mg and swallowed fluticasone 880 micrograms daily.No maintenance medication was routinely used after the treatment.RESULTS: Seven men and one woman with mean age at 35 yearswere evaluated. Seven patients presented with food impaction.Five patients had typical ringed-appearing esophagus. All patientshad eosinophilic infiltration more than 15 per high power fieldhistologically. Five patients (62.5%) had resolved or improvedsymptoms after the treatment. Two patients (25%) had recurrentbut less severe symptoms 2 and 12 months after the treatment,respectively.CONCLUSIONS: EoE affects predominantly middle-aged men andcommonly presents with food impactions. The regimen of combinedpantoprazole, montelukast and fluticasone might be effective intreating EoE and reducing recurrent symptoms. Additional studies,however, are warranted to further investigate the efficacy.