Comparison of Esomeprazole to Aerosolized, Swallowed Fluticasone for Eosinophilic Esophagitis

Inclusion Criteria: Patients aged 18-80 with EE, defined as: a) dysphagia, food impaction or other upper gastrointestinal symptoms (chest pain, heartburn, regurgitation); b) multiple esophageal rings or furrows; c) the presence of >20 eosinophils/high power field in the squamous epithelium or deeper tissues of the esophagus Ability to undergo esophageal manometry and ambulatory pH monitoring No history of bleeding diathesis, significant cardiopulmonary disease, or other contraindication to upper endoscopy Those who have had a one month holiday from either esomeprazole therapy or fluticasone if they have been prescribed this prior to enrollment Exclusion Criteria: Contraindication to proton pump inhibitors or swallowed fluticasone Need for immediate esophageal dilation at enrollment due to food impaction at the discretion of the performing endoscopist Inability to pass endoscope Pregnancy Incarceration Inability to provide informed consent History of esophago-gastric surgery or prior history of abdominal surgery with subsequent strictures or symptoms of obstruction such as abdominal pain and bloating Presence of other esophageal pathology that could account for patients' symptoms as determined by histological interpretation by the pathologist History of esophageal spasm resulting in trouble swallowing foods larger than 1 cm in diameter