BACKGROUND: Both gastroesophageal reflux disease and allergy/atopy have been 
implicated in the pathogenesis of eosinophilic esophagitis (EoE). There are no 
prospective studies comparing treatment of EoE with acid suppression versus 
topical corticosteroids.
OBJECTIVE: To determine the outcome of adult eosinophilic esophagitis patients 
treated with esomeprazole versus topical fluticasone.
DESIGN: Prospective randomized controlled trial.
SETTING: Academic medical center.
PARTICIPANTS: Adults (18-80) diagnosed with EoE by symptoms of dysphagia and 
esophageal biopsies with >or=15 eosinophils/hpf.
INTERVENTIONS: Subjects were randomized to esomeprazole (40 mg by mouth every 
morning) or aerosolized, swallowed fluticasone (440 mcg by mouth twice a day) 
for 8 weeks.
MAIN OUTCOME MEASUREMENTS: Improvement in dysphagia (8-point scale), esophageal 
eosinophil infiltration before and after treatment, prevalence of GERD measured 
by validated questionnaire and baseline pH study.
RESULTS: About 56% (14/25) had acid reflux by pH study. There was no difference 
between treatment groups in improvement in dysphagia scores [3/12 (25%) of the 
esomeprazole group versus 6/12 (50%) in the fluticasone group, P = 0.40]. 
Eosinophil infiltration decreased with treatment in both groups, and there was 
no difference in the amount of decrease between groups (P = 0.70).
LIMITATIONS: Small sample size, unexpectedly high drop-out rate.
CONCLUSIONS: Gastroesophageal reflux disease is common in adult eosinophilic 
esophagitis patients. Dysphagia improves and esophageal eosinophilic 
infiltration decreases with either treatment. There was no difference in degree 
of improvement in dysphagia or eosinophil infiltration in patients treated with 
either topical fluticasone or oral esomeprazole. GERD may be important in the 
pathogenesis of adult EoE.