Eosinophilic Esophagitis: Influence of Dilation on Dysphagia and Inflammation

NCT ID: NCT00667524

Last Updated: 2009-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

207 participants

Study Classification

OBSERVATIONAL

Study Start Date

2008-02-29

Study Completion Date

2009-03-31

Brief Summary

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A database analysis and review of histological slides (retrospective) and a patient questionnaire analysis (prospective) will be conducted in Bern (Switzerland) to evaluate the efficacy and safety of esophageal dilation and its effect on the underlying eosinophilic inflammation in patients with Eosinophilic Esophagitis. This trial is investigator driven.

Detailed Description

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Eosinophilic esophagitis (EE) is a chronic, increasingly recognized disease of the esophagus, clinico-pathologically characterized by a proton-pump-inhibitor resistant, dense esophageal eosinophilia in combination with esophagus-related symptoms. Patients suffer mainly from dysphagia, a feared long-term complication is the evolution of esophageal stenoses leading to food-bolus impaction that have to be removed endoscopically. Anti-inflammatory therapy with systemic or topical corticosteroids have shown to be efficacious in children as well as in adults. However, relapses occur in general soon after the cessation of this medication. In addition, several studies have demonstrated that in adults with active EE dilation is an alternative safe and efficacious therapeutic option. Surprisingly, the symptom-free period seems to be much longer after this procedure than after medical treatment. Today, the selection of these two procedures depends more on local practices than on evidence based data, because robust data are lacking. Furthermore, there are concerns regarding the risk of the dilation-procedure (possible esophageal perforations and major bleeding). Furthermore, it has not yet been assessed if dilation changes the underlying eosinophilic inflammation. If not, investigations should be performed to evaluate if long-term anti-eosinophilic therapy is able to change the natural course of the disease and reduce the stricturing complications.

Conditions

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Eosinophilic Esophagitis Esophageal Stenosis Esophageal Dilation Esophageal Dilatation

Keywords

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Eosinophilic Esophagitis Dysphagia Esophageal bougienage Esophageal Dilation

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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I

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

1. Pre-dilational upper endoscopy (EGD) including histology and
2. Dilation and
3. Post-dilational EGD/Histo
* Definitions: Active EE is defined as

1. Symptoms of dysphagia on almost each intake of solid food when off anti-inflammatory therapy or dietary restriction;
2. Presence of an eosinophilic tissue infiltration with a peak cell density of \>24 eosinophils per hpf x 400 on histology of esophageal biopsies.
* Work-Up: "Comparable" time frame between baseline and post-dilational biopsy sampling

Exclusion Criteria

* Therapy with anti-eosinophilic medications 12 weeks prior to pre-dilational EGD and dilation respectively and between dilation and post-dilational EGD/Histo.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Northwestern University Feinberg School of Medicine

OTHER

Sponsor Role collaborator

University of Bern

OTHER

Sponsor Role lead

Responsible Party

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Dpt of Gastroenerology, Bern University Hospital, Bern

Principal Investigators

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Alain Schoepfer, Dr

Role: PRINCIPAL_INVESTIGATOR

Dpt of Gastroenterology, Bern University Hospital, Bern

Locations

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Dpt of Gastroenterology, Bern University Hospital

Bern, , Switzerland

Site Status

Countries

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Switzerland

References

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Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, Bonis P, Hassall E, Straumann A, Rothenberg ME; First International Gastrointestinal Eosinophil Research Symposium (FIGERS) Subcommittees. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007 Oct;133(4):1342-63. doi: 10.1053/j.gastro.2007.08.017. Epub 2007 Aug 8.

Reference Type BACKGROUND
PMID: 17919504 (View on PubMed)

Potter JW, Saeian K, Staff D, Massey BT, Komorowski RA, Shaker R, Hogan WJ. Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest Endosc. 2004 Mar;59(3):355-61. doi: 10.1016/s0016-5107(03)02713-5.

Reference Type BACKGROUND
PMID: 14997131 (View on PubMed)

Ngo P, Furuta GT, Antonioli DA, Fox VL. Eosinophils in the esophagus--peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia. Am J Gastroenterol. 2006 Jul;101(7):1666-70. doi: 10.1111/j.1572-0241.2006.00562.x.

Reference Type BACKGROUND
PMID: 16863575 (View on PubMed)

Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology. 2003 Dec;125(6):1660-9. doi: 10.1053/j.gastro.2003.09.024.

Reference Type BACKGROUND
PMID: 14724818 (View on PubMed)

Desai TK, Stecevic V, Chang CH, Goldstein NS, Badizadegan K, Furuta GT. Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc. 2005 Jun;61(7):795-801. doi: 10.1016/s0016-5107(05)00313-5.

Reference Type BACKGROUND
PMID: 15933677 (View on PubMed)

Baxi S, Gupta SK, Swigonski N, Fitzgerald JF. Clinical presentation of patients with eosinophilic inflammation of the esophagus. Gastrointest Endosc. 2006 Oct;64(4):473-8. doi: 10.1016/j.gie.2006.03.931. Epub 2006 Jul 26.

Reference Type BACKGROUND
PMID: 16996334 (View on PubMed)

Konikoff MR, Noel RJ, Blanchard C, Kirby C, Jameson SC, Buckmeier BK, Akers R, Cohen MB, Collins MH, Assa'ad AH, Aceves SS, Putnam PE, Rothenberg ME. A randomized, double-blind, placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis. Gastroenterology. 2006 Nov;131(5):1381-91. doi: 10.1053/j.gastro.2006.08.033. Epub 2006 Aug 16.

Reference Type BACKGROUND
PMID: 17101314 (View on PubMed)

Remedios M, Campbell C, Jones DM, Kerlin P. Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate. Gastrointest Endosc. 2006 Jan;63(1):3-12. doi: 10.1016/j.gie.2005.07.049.

Reference Type BACKGROUND
PMID: 16377308 (View on PubMed)

Schoepfer AM, Gschossmann J, Scheurer U, Seibold F, Straumann A. Esophageal strictures in adult eosinophilic esophagitis: dilation is an effective and safe alternative after failure of topical corticosteroids. Endoscopy. 2008 Feb;40(2):161-4. doi: 10.1055/s-2007-995345.

Reference Type BACKGROUND
PMID: 18253909 (View on PubMed)

Schoepfer AM, Gonsalves N, Bussmann C, Conus S, Simon HU, Straumann A, Hirano I. Esophageal dilation in eosinophilic esophagitis: effectiveness, safety, and impact on the underlying inflammation. Am J Gastroenterol. 2010 May;105(5):1062-70. doi: 10.1038/ajg.2009.657. Epub 2009 Nov 24.

Reference Type RESULT
PMID: 19935783 (View on PubMed)

Other Identifiers

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KEK031_08

Identifier Type: -

Identifier Source: org_study_id