TREATMENT OF EOSINOPHILIC ESOPHAGITIS WITH INHALED BUDESONIDE IN A 7-YEAR-OLD BOY WITH CONCOMITANT PERSISTENT ASTHMA: RESOLUTION OF ESOPHAGEAL SUBMUCOSAL FIBROSIS AND EOSINOPHILIC INFILTRATION

摘要

Eosinophilic esophagitis (EE) is being increasingly recognized in children and adults with dysphagia, food impaction, vomiting, abdominal pain, and heartburn not responsive to gastric acid suppression. Esophageal biopsy specimens in patients with EE demonstrate intraepithelial eosinophilic infiltration and fibrosis when compared with the specimens of healthy individuals and of patients with gastroesophageal reflux disease.1 Successful treatment of EE with moderate- to high-dose swallowed inhaled fluticasone propionate has been reported.2"4 However, in a recent, randomized, double-blind, placebo-controlled trial,5 histologic resolution occurred in only 10 of 20 patients with EE treated with high-dose swallowed fluticasone propionate. In addition, reports of EE being successfully treated with elemental diets, selective elimination diets, anti-interleukin 5 monoclonal antibody, and oral corticosteroids have been published. None of these studies have reported on the outcome of esophageal submucosal fibrosis with therapy. Herein, we present a case of a young boy with asthma and EE successfully treated with 2 months of inhaled dry powder budesonide. Using quantitative image analysis, we demonstrate, for the first time to our knowledge,a marked decrease in submucosal collagen deposition as a result of treatment with topical budesonide