***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Eosinophilic esophagitis ( EoE ) is a chronic , Th2‐type inflammatory disease . Chemoattractant receptor‐homologous molecule on Th2 cells ( CRTH2 ) is a prostagl and in D2 ( PGD2 ) receptor , expressed by Th2 cells and other inflammatory cells , including eosinophils and basophils , that mediates chemotaxis and activation . OC000459 is a selective CRTH2 antagonist and would be expected to suppress eosinophilic tissue inflammation . The purpose of this study was to evaluate the efficacy and safety of an OC000459 monotherapy in adult patients with active , corticosteroid‐dependent or corticosteroid‐refractory BACKGROUND & AIMS Eosinophilic esophagitis is an increasingly recognized disorder with distinctive endoscopic , histologic , and allergic features . Although several therapies are advocated , no placebo-controlled trials have been conducted . We aim ed to determine the efficacy of swallowed fluticasone propionate ( FP ) in the treatment of eosinophilic esophagitis . METHODS We conducted a r and omized , double-blind , placebo-controlled trial of swallowed FP in pediatric patients with active eosinophilic esophagitis . Thirty-six patients were r and omly assigned to receive either 880 mug of FP ( 21 patients ) or placebo ( 15 patients ) divided twice daily for 3 months . The primary end point was histologic remission , defined by a peak eosinophil count of < /=1 eosinophil in all 400x fields in both the proximal and distal esophagus . RESULTS Fifty percent of FP-treated patients achieved histologic remission compared with 9 % of patients receiving placebo ( P = .047 ) . FP decreased esophageal eosinophil levels , with a more pronounced effect in nonallergic individuals ( 65.9 + /- 25.3 vs 1.4 + /- 1.1 eosinophils/high-power field in the proximal esophagus [ P = .03 ] and 84.6 + /- 19.7 vs 19.6 + /- 12.9 eosinophils/high-power field in the distal esophagus [ P = .04 ] ) . Resolution of vomiting occurred more frequently with FP than placebo ( 67 % vs 27 % ; P = .04 ) . FP-induced  resolution of mucosal eosinophilia was associated with resolution of endoscopic findings , epithelial hyperplasia , younger age ( P = .0003 ) , shorter height ( P = .002 ) , and lighter weight ( P = .02 ) . Effective treatment with FP decreased the number of CD8(+ ) T lymphocytes and mast cells in both the proximal and distal esophagus ( P < .05 ) . CONCLUSIONS Swallowed FP is effective in inducing histologic remission in eosinophilic esophagitis , with a more pronounced effect in nonallergic and younger individuals , especially in the proximal esophagus BACKGROUND Eosinophilic esophagitis ( EoE ) is a chronic allergic disease with limited treatment options . OBJECTIVE We evaluated QAX576 , an mAb against IL-13 , in the treatment of patients with EoE. METHODS Patients ( 18 - 50 years ) with proton pump inhibitor-resistant esophageal eosinophilia received intravenous QAX576 ( 6 mg/kg ) or placebo ( 2:1 ) at weeks 0 , 4 , and 8 and were followed for 6 months . The primary end point was the responder rate for a greater than 75 % decrease in peak eosinophil counts at week 12 . Efficacy was to be declared if the lower 90 % confidence limit for the proportion of responders on QAX576 was 35 % or greater . Secondary end points included changes in esophageal eosinophil counts , symptoms assessed by question naire scores , and quantification of a series of biomarkers . RESULTS Twenty-three patients completed the study up to week 12 , and 18 continued to the end of the study . For the proximal and distal esophageal biopsies combined , the responder rate was 12.5 % ( 90 % confidence limit , 1 % to 43 % ) with placebo , compared to 40.0 % ( 90 % confidence limit , 22 % to 61 % ) with QAX576 . Although the primary end point was not met , the mean esophageal eosinophil count decreased by 60 % with QAX576 versus an increase of 23 % with placebo ( P = .004 ) , and the decrease was sustained up to 6 months . There was a trend for improved symptoms , particularly dysphagia . QAX576 improved expression of EoE-relevant esophageal transcripts , including eotaxin-3 , periostin , and markers of mast cells and barrier function , for up to 6 months after treatment . QAX576 was well tolerated . CONCLUSIONS QAX576 significantly improved intraepithelial esophageal eosinophil counts and dysregulated esophageal disease-related transcripts in adults with EoE in a sustained manner Background & Aims : The endoscopic reference score ( EREFS ) is used to determine severity of 5 endoscopic findings : edema , rings , exu date s , furrows , and strictures . Little is known about the relationship between EREFSs and histologic markers of disease activity in children with eosinophilic esophagitis ( EoE ) . We aim ed to determine whether the EREFS can be used to identify children with EoE and how it changes with treatment . Methods : We performed a prospect i ve study of consecutive children ( ages 2–17 years ) undergoing diagnostic or post‐treatment endoscopy scored real‐time with EREFS from December 2012 through 2016 . Findings from 192 diagnostic endoscopies and 229 post‐treatment endoscopies were evaluated , from 371 children . Incident EoE cases were diagnosed based on 2011 consensus guidelines . Patients were treated with either elimination diet or topical steroids . Subjects who underwent endoscopy for symptoms of esophageal dysfunction but had normal esophageal findings from histology analysis were used as controls . EREFS and receiver operating characteristic curves were determined for incident EoE cases ( n = 77 ) vs controls ( n = 115 ) , patients with active EoE ( n = 101 ) vs inactive EoE after treatment ( n = 128 ) , and paired pre‐ and post‐treatment cases of EoE ( n = 85 ) . Component and composite scores were correlated with eosinophilia . Results : Visual detection of more than 1 esophageal abnormality during the diagnostic endoscopy identified children with EoE with 89.6 % sensitivity and 87.9 % specificity . EREFS correlated with peak level of eosinophilia ( P < .001 ) at all esophageal levels . Children who responded to therapy had mean EREFSs of 0.5 compared to 2.4 in non‐responders . In comparing pre‐treatment vs post‐treatment data from 85 patients , we found a significant reduction in the composite EREFS ( from 2.4 to 0.7 ) ( P < .001 ) among patients who responded to treatment ; 92 % of responders had a reduced EREFSs after treatment . EREFSs identified children with EoE with an area under the curve value ( AUC ) of 0.93 . EREFSs identified children with active EoE following treatment with an AUC of 0.81 before treatment and an AUC of 0.79 after treatment . Conclusions : In a prospect i ve study of children undergoing diagnostic or post‐treatment endoscopy , we found the EREFS to accurately identify those with EoE. Children who responded to therapy had lower EREFS scores than non‐responders . EREFSs can be used to measure outcomes of pediatric patients , in conjunction with histology findings , and assess treatments for children with Objectives : For technical reasons , the histologic characterization of eosinophilic esophagitis (EoE)-specific alterations is almost exclusively based on those found in the esophageal epithelium , whereas little is known about subepithelial abnormalities . In this study , we aim ed to systematic ally assess the nature of subepithelial histologic alterations , and analyze their relationship with epithelial histologic findings , endoscopic features , and symptoms . Methods : Adult patients with established EoE diagnosis were prospect ively included during a yearly follow-up visit . Patients underwent assessment of clinical , endoscopic , and histologic disease activity using EoE-specific scores . Results : We included 200 EoE patients ( mean age 43.5±15.7 years , 74 % males ) with a median peak count of 36 intraepithelial eosinophils/hpf ( IQR 14−84 ) . The following histologic features were identified in the subepithelial layer : eosinophilic infiltration ( median peak count of 20 eosinophils/hpf ( IQR 10−51 ) ) , eosinophil degranulation ( 43 % ) , fibrosis ( 82 % ) , and lymphoid follicles ( 56 % ) . Peak intraepithelial eosinophil counts were higher , identical , and lower when compared to the subepithelial layer in 62.5 % , 7 % , and 30.5 % of patients , respectively . Anti-eosinophilic treatment at inclusion did not influence the relation between subepithelial and epithelial peak eosinophil counts . Subepithelial histologic activity correlated with epithelial histologic activity ( rho 0.331 , P<0.001 ) , endoscopic severity ( rho 0.208 , P=0.003 ) , and symptom severity ( rho 0.179 , P=0.011 ) . Forty percent ( 21/52 ) of patients with < 15 intraepithelial eosinophils/hpf had subepithelial peak counts of ≥15/hpf . Conclusions : There is a significant but modest correlation between subepithelial histologic activity and epithelial histologic activity , endoscopic severity , and symptom severity . The long-term clinical impact of assessing subepithelial alterations in EoE needs to be further eluci date BACKGROUND & AIMS Pharmacologic treatment of eosinophilic esophagitis ( EoE ) is limited to off-label use of corticosteroids not optimized for esophageal delivery . We performed a r and omized , controlled phase 2 trial to assess the ability of budesonide oral suspension ( BOS ) , a novel muco-adherent topical steroid formulation , to reduce symptoms and esophageal eosinophilia in adolescents and adults with EoE. METHODS In this multicenter , r and omized , double-blind , placebo-controlled , parallel-group trial , 93 EoE patients between the ages of 11 and 40 years with dysphagia and active esophageal eosinophilia were r and omized to receive either BOS 2 mg or placebo twice daily for 12 weeks . Co- primary outcomes were change in Dysphagia Symptom Question naire ( DSQ ) score from baseline , and proportion of patients with a histologic response ( ≤6 eosinophils/high-power field ) after treatment . Endoscopic severity scores and safety parameters were assessed . RESULTS At baseline , mean DSQ scores were 29.3 and 29.0 , and mean peak eosinophil counts were 156 and 130 per hpf in the BOS and placebo groups , respectively . After treatment , DSQ scores were 15.0 and 21.5 , and mean peak eosinophil counts were 39 and 113 per high-power field , respectively ( P < .05 for all ) . For BOS vs placebo , change in DSQ score was -14.3 vs -7.5 ( P = .0096 ) , histologic response rates were 39 % vs 3 % ( P < .0001 ) , and change in endoscopic severity score was -3.8 vs 0.4 ( P < .0001 ) . Adverse events were similar between groups . CONCLUSIONS Treatment with BOS was well tolerated in adolescent and young adult patients with EoE and result ed in improvement in symptomatic , endoscopic , and histologic parameters using vali date d outcome instruments . Clinical Trials.gov ID NCT01642212 BACKGROUND & AIMS The aim of this study was to assess whether measurements of esophageal distensibility , made by high-resolution impedance planimetry , correlated with important clinical outcomes in patients with eosinophilic esophagitis . METHODS Seventy patients with eosinophilic esophagitis ( 50 men ; age , 18 - 68 y ) underwent endoscopy with esophageal biopsy collection and high-resolution impedance planimetry using the functional lumen-imaging probe .  The patients were followed up prospect ively for an average of 9.2 months ( range , 3 - 14 mo ) , and the risk of food impaction , requirement for dilation 
    Output:
    
The EoE Endoscopic Reference Score is the most commonly applied tool for describing changes in endoscopic appearance .