Digestive Diseases and Sciences

, Volume 56, Issue 12, pp 3551–3558

Montelukast Was Inefficient in Maintaining Steroid-Induced Remission in Adult Eosinophilic Esophagitis

  • Alfredo J. Lucendo
  • Livia C. De Rezende
  • Susana Jiménez-Contreras
  • Jose Luis Yagüe-Compadre
  • Jesús González-Cervera
  • Teresa Mota-Huertas
  • Danila Guagnozzi
  • Teresa Angueira
  • Sonia González-Castillo
  • Ángel Arias
Original Article

DOI: 10.1007/s10620-011-1775-y

Cite this article as:
Lucendo, A.J., De Rezende, L.C., Jiménez-Contreras, S. et al. Dig Dis Sci (2011) 56: 3551. doi:10.1007/s10620-011-1775-y

Abstract

Background and Aims

Leukotriene D4 is produced by and functions as a chemotactic factor for eosinophils. Eosinophilic esophagitis (EoE) is characterized by esophageal eosinophilic infiltration, determining structural changes and dismotility symptoms. Montelukast, a selective leukotriene D4 receptor antagonist, has gained increasing consideration as a therapeutic agent for EoE. However, limited available information has shown that montelukast is not effective in reducing eosinophilic infiltration. Our paper aims at evaluating whether montelukast could be consider as a steroid-sparing therapy by assessing its efficacy in maintaining both clinical and histopathological remission achieved after topical corticosteroids in adult EoE patients.

Methods

Eleven consecutively diagnosed adult EoE patients were prospectively studied. Esophageal biopsies were obtained before and after a 6-month treatment with fluticasone propionate 400 μg/twice a day. Immediately after that, montelukast 10 mg/day was instituted. A new endoscopy was foreseen after a new 3-month period, or as soon as the patients presented esophageal symptoms. Symptoms were assessed by using a questionnaire before and after fluticasone propionate treatment and after montelukast therapy.

Results

Eosinophils density into the esophageal epithelium and lamina propria was significantly reduced after a 6-month treatment with topical steroids (P = 0.003) and increased to levels similar to baseline level into the first 3 months after treatment with montelukast. Baseline symptom scores significantly decreased after treatment with topical steroids (P = 0.003) and increased again after montelukast therapy, but baseline levels improved.

Conclusions

Montelukast was not efficient in maintaining the histopathological or clinical response achieved by topical steroids in adult EoE patients.

Keywords

Eosinophilic esophagitisAllergic esophagitisMontelukastAnti-leukotrieneLeukotriene D4Dysphagia

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Alfredo J. Lucendo
    • 1
  • Livia C. De Rezende
    • 1
  • Susana Jiménez-Contreras
    • 1
  • Jose Luis Yagüe-Compadre
    • 3
  • Jesús González-Cervera
    • 4
  • Teresa Mota-Huertas
    • 3
  • Danila Guagnozzi
    • 1
  • Teresa Angueira
    • 1
  • Sonia González-Castillo
    • 1
  • Ángel Arias
    • 2
  1. 1.Department of GastroenterologyHospital General de TomellosoTomelloso, Ciudad RealSpain
  2. 2.Research UnitComplejo Hospitalario La Mancha CentroAlcázar de San Juan, Ciudad RealSpain
  3. 3.Department of PathologyComplejo Hospitalario La Mancha CentroAlcázar de San Juan, Ciudad RealSpain
  4. 4.Department of AllergyHospital General de TomellosoTomelloso, Ciudad RealSpain