To assess through MRI the existence of an inflammatory and fibrotic component in strictures of eosinophilic esophagitis patients and to determine if this component is responsive to a therapeutic course of budesonide.

Eosinophilic Esophagitis

MRI will be performed on a 1.5T magnet. Patients will be scanned in an oblique prone position similar to how esophageal distention is assessed at barium fluoroscopy

MRI to detect inflammation and fibrosis in subjects with EoE

Mayo Clinic in Rochester

MRI to Assess Fibrosis in Eosinophilic Esophagitis Patients

Assessment of Fibrotic and Inflammatory Components by MRI in Strictures Associated With Eosinophilic Esophagitis Before and After Treatment

At 5,15 and 25 cm above the gastroesophageal junction and in areas of obvious esophageal thickness, digitized areas of inflammation and fibrosis will be measured individually and as a proportion of overall esophageal diameter in that area before and after steroid treatment.

The barium esophagram will measure moderate stricture formation to delineate the groups- Group 1.(narrowed segment <8 cm in length and lumen diameter > 12mm) and Group 2- 10 will have small caliber esophagus (a narrowed segment >8 cm in length with minimum diameter < 10mm).

Questionnaire developed to measure dysphagia - using the pro scoring method

David A. Katzka

Principal Investigator

Mayo Clinic

Twenty patients with eosinophilic esophagitis will be studied. Ten of these patients will have mild to moderate stricture formation (narrowed segment <8 cm in length and lumen diameter > 12mm) and 10 will have small caliber esophagus (a narrowed segment >8 cm in length with minimum diameter < 10mm). These groups will be delineated by routine barium esophagography performed in all Mayo patients with eosinophilic esophagitis during their initial clinical evaluation. Patients will then undergo an 8 week treatment with 3 mg budesonide twice daily as per routine clinical treatment with clinically indicated follow up endoscopy with esophageal biopsies to assess mucosal response. All patients will complete the EESAI dysphagia score per routine practice at Mayo. MRI of the esophagus will be performed in these patients initially and upon completion of the 8 week course of steroid therapy.

Subjects with current or historical diagnosis of EoE, or suspected of having EoE will complete the Esophageal String Test (EST) and EndoFLIP

The EST is a gelatin capsule filled with a 90cm nylon string. A trailing end of the string protrudes from one end of the capsule. This end is taped to the cheek and the capsule is swallowed. As the capsule travels to the small intestine, the string inside the capsule is dislodged, leaving a string that goes from the cheek to the small intestine. The capsule dislodges from the string and the string is left in place, in the mouth, esophagus, stomach and small intestine for an hour. During this time, the string rubs against the inside of the esophagus and collects eosinophil proteins. After one hour, the string is removed through the mouth and placed in preservative to save the eosinophil proteins.

Esophageal String Test (EST)

Children's Hospital Colorado

Use of Esophageal String Test to Understand Symptoms, Inflammation, and Function in Eosinophilic Esophagitis

Measure the concentration of eosinophilic degranulating protein on strings that have been swallowed by subjects diagnosed with EoE

University of Colorado, Denver

Children's Hospital of Philadelphia

Subjects will receive two 5mg tablets of Montelukast/day.

Subjects will receive one 5mg tablet of montelukast and 1 placebo tablet per day.

Subjects will receive two placebo tablets per day.

Those in Montelukast 10mg/day group will receive two 5mg tablets of Montelukast.

Montelukast

Those in the placebo group will receive 2 placebo tablets per day. Those in the Montelukast 5mg/day will receive 1 placebo tablet per day.

placebo

Subject will receive one 5mg tablet of Montelukast and one placebo tablet per day.

eosinophilic esophagitis/obrzęk

MRI to Assess Fibrosis in Eosinophilic Esophagitis Patients

Use of Esophageal String Test to Understand Symptoms, Inflammation, and Function in Eosinophilic Esophagitis

A Trial of Montelukast for Maintenance Therapy of Eosinophilic Esophagitis in Children

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