A recent study (EJ Laserna-Mendieta et al. Clin Gastroenterol Hepatol 2020; 18: 2903-2911. Full text: Efficacy of Therapy for Eosinophilic Esophagitis in Real-World Practice) highlights the disconnect between clinical practice and outcomes.
- Methods: This study relied on the multicenter EoE CONNECT database—with 589 patients.
- Clinical remission was < 50% in Dysphagia Symptom Score; any improvement in symptoms = clinical response.
- Histologic remission was eosinophil count below 5 eosinophils/hpf; 5-14/hpf = histologic response.
- Topical steroids were most effective in inducing histologic remission: 54.8% compared to 36.1% for PPIs and 18.5% for empiric elimination diet; histologic remission and response was 67.7%, 49.7%, and 48.1% respectively.
- Topical steroids were most effective in inducing clinical and histologic remission or response (in 67.7% of patients), followed by empiric elimination diets (in 52.0%), and PPIs (in 50.2%).
- However, PPIs were the first-line treatment for 76.4% of patients, followed by topical steroids (for 10.5%) and elimination diets (for 7.8%).
My take: This data (and others) indicate that topical steroids are most effective pharmacologic therapy; at some point, I expect that they will become the most frequently used.
Related blog posts:
- 2020 Eosinophilic Guidelines (AGA)
- Eosinophilic Esophagitis -FAQs
- What Happens When Topical Steroids Are Stopped in EoE?
- Eosinophilic Esophagitis -Up to Date Dietary Management Review
- Predicting Response to Topical Steroids in EoE
- Diet and Stress in Pediatric Eosinophilic Esophagitis
- Useful information on EoE Dietary Therapies
- What is EoE?
- EoE Update 2018 (Dr. Seth Marcus)
- Updated Consensus Guidelines for Eosinophilic Esophagitis
- Nexium versus Fluticasone for EoE | gutsandgrowth
- Do We Still Need PPI-REE? | gutsandgrowth
“Layering two less specialized masks on top of each other can provide comparable protection [to N95]. Dr. Marr recommended wearing face-hugging cloth masks over surgical masks, which tend to be made with more filter-friendly materials but fit more loosely. An alternative is to wear a cloth mask with a pocket that can be stuffed with filter material, like the kind found in vacuum bags.”
Unrelated from NY Times: One Mask Is Good. Would Two Be Better? (Yes)