Fluticasone Versus Esomeprazole to Treat Eosinophilic Esophagitis

The purpose of this study is to assess the clinical efficacy of proton pump inhibitors in
comparison to aerosolized swallowed steroids for the treatment of eosinophilic esophagitis
(EE). EE is an increasingly recognized disorder that has been associated with dysphagia and
food impaction. The presence of anatomical abnormalities in the esophagus such as
longitudinal furrows, corrugated rings and a narrow caliber esophagus with friable mucosa
are classic endoscopic findings. Diagnosis is established with the histologic finding of
large numbers (> 15) of eosinophils per high power field. The underlying pathologic
mechanism remains poorly understood but food allergies and aeroallergens have been
implicated. It is well known that gastroesophageal reflux disease (GERD) may cause
esophageal eosinophilia, but it is unclear whether a complex relationship exists between
GERD and EE, as recent data suggests. Furthermore, a large number of patients with clinical
presentations and endoscopic findings highly suggestive of EE which is confirmed on
histology are responding favorably to proton pump inhibitors.

The aims of the study are to (1) compare the clinical efficacy of aerosolized swallowed
Fluticasone to Esomeprazole for the treatment of eosinophilic esophagitis, (2) determine
whether proton pump inhibitors are effective in the treatment of eosinophilic esophagitis,
(3) determine the number of patients with eosinophilic esophagitis that have coexisting
gastroesophageal reflux disease, and (4) correlate change in eosinophil count to improvement
in symptoms before and after therapy.