Testing Effectiveness of Losartan in Patients With EoE With or Without a CTD

• Number of participants with reduction of esophageal eosinophils [ Time Frame: up to five years ]

  Tissue samples will be obtained from the esophagus from participants to determine the effects of losartan compared to placebo on the reduction of esophageal eosinophils in participants with eosinophilic esophagitis with or without a connective tissue disorder. It is planned to evaluate the reduction as follows:

  1. % of participants with reduction of eosinophil count to =<1/hpf
  2. % of participants with reduction of eosinophil count to less than 15
  3. Average reduction in eosinophil count
  4. Comparison across groups with and without a connective tissue disorder
• Number of participants with reduction of esophageal eosinophils [ Time Frame: up to five years ]

  Tissue samples will be obtained from the esophagus from participants to determine the effects of losartan compared to placebo on the reduction of esophageal eosinophils in participants with eosinophilic esophagitis with or without a connective tissue disorder. It is planned to evaluate the reduction as follows:

  1. % of participants with reduction of eosinophil count to =<1hpf
  2. % of participants with reduction of eosinophil count to less than 15
  3. Average reduction in eosinophil count
  4. Comparison across groups with and without a connective tissue disorder

• Number of participants with reduction in levels of the transforming growth factor beta protein. [ Time Frame: up to five years ]
  Blood and tissue samples will be obtained from participants throughout the study to evaluate losartan on the reduction in levels of transforming growth factor beta (TGF-β pg/mL) in the blood and esophagus.
• Number of participants that experience normalization of the EoE transcriptome [ Time Frame: up to five years ]
  Blood and tissue samples will be obtained throughout the trial to investigate the number of participants that experience a normalization of the EoE transcriptome, mRNA expression fold difference <2 compared to normal controls in participants with EoE with or without a connective tissue disorder
• Number of participants that have an improved score utilizing the Patient Reported Outcome questionnaires to assess for clinical symptom response. [ Time Frame: up to five years ]
  To evaluate the effect of losartan by utilizing the Patient Reported Outcome questionnaires (metric scoring algorithm) to assess for clinical symptom response.
• Number of participants that have an improved score on the histology scoring system. [ Time Frame: up to five years ]
  To evaluate the effect of losartan by a study staff member pathologist scoring the tissue samples by utilizing the histology scoring system. This scoring system was created to express the severity and extent of abnormalities in the gastrointestinal tract that often accompany eosinophilic inflammation.
• To determine the safety of Losartan [ Time Frame: up to five years ]
  To determine the safety of losartan by the absences of adverse events will be recorded in participants with Eosinophilic Esophagitis with or without a connective tissue disorder.

• Number of participants with reduction in levels of the transforming growth factor beta protein. [ Time Frame: up to five years ]
  Blood and tissue samples will be obtained from participants throughout the study to evaluate losartan versus a placebo on the reduction in levels of transforming growth factor beta (TGF-β pg/mL) in the blood and esophagus. Comparisons will be made between the placebo and losartan treated groups.
• Number of participants that experience normalization of the EoE transcriptome [ Time Frame: up to five years ]
  Blood and tissue samples will be obtained throughout the trial to investigate the number of participants that experience a normalization of the EoE transcriptome, mRNA expression fold difference <2 compared to normal controls in participants with EoE with or without a connective tissue disorder
• Number of participants that have an improved score utilizing the Patient Reported Outcome questionnaires to assess for clinical symptom response. [ Time Frame: up to five years ]
  To evaluate the effect of losartan versus a placebo by utilizing the Patient Reported Outcome questionnaires (metric scoring algorithm) to assess for clinical symptom response. Comparisons will be made between the placebo and losartan treated groups.
• Number of participants that have an improved score on the histology scoring system. [ Time Frame: up to five years ]
  To evaluate the effect of losartan versus placebo by a study staff member pathologist scoring the tissue samples by utilizing the histology scoring system. This scoring system was created to express the severity and extent of abnormalities in the gastrointestinal tract that often accompany eosinophilic inflammation. Comparisons will be made between the placebo and losartan treated groups.
• To determine the safety of Losartan versus placebo [ Time Frame: up to five years ]
  To determine the safety of losartan versus placebo by the absences of adverse events will be recorded in participants with Eosinophilic Esophagitis with or without a connective tissue disorder.

Losartan is a drug that is approved by the United States Food and Drug Administration (FDA) for use in adults and children over 6 years of age who have high blood pressure. Losartan has been safe when administered to patients with normal blood pressure. This medication has not been studied in people with eosinophilic esophagitis or connective tissue disorder. Eosinophils are a type of white blood cell that induces inflammation. Eosinophils with other inflammatory cells produce a protein called TGF-β, which may contribute to part of EoE. Losartan may reduce the amount of this protein and therefore, be a treatment for eosinophilic esophagitis.

You will be in the research study for approximately 4 months. Participation in this research study will involve 9 study visits. Of the 9 study visits, at least 3 visits will take place in the clinic; the other visits may take place over the telephone.

Throughout the study, the following activities will occur:

1. A physical and vital signs will be obtained
2. There will be two endoscopies performed one at the beginning and one at the end of the study
3. Blood will be obtained up to three times
4. Pregnancy tests will be performed
5. Quality-of-life questionnaires will be completed

This is an open-label trial, which means that if you choose to enroll and you meet screening criteria, you will receive Losartan as a treatment. You will start the study drug at a low dose. It will be increased at vist 3 the 1 month visit. The dose of study drug will be increased depending on your weight and how well you tolerate each dose but will not exceed 100mg of study drug per day. It may be increased or decreased during the study if there are any side effects. If you do not have certain side effects, you will take each dose of the study drug between 21 and 28 days until your next study visit. You will swallow a pill or liquid once or twice a day.

This study will consist of 4 phases: screening, treatment (titration and maintenance), end of treatment, and follow-up. Participants that are between 5 to 18 years of age, as well as the parent or legal guardian will be asked to complete questionnaires of quality-of-life symptom severity questionnaires. Participants between the age of 19 and 21 will also have to fill out these questionnaires, but parents/guardians will not have to fill these out. If you are the parent or caretaker, the only study activity in which you will be involved is the completion of questionnaires about you and your family.

• Eosinophilic Esophagitis
• Connective Tissue Disorders

• Experimental: EoE Only
  Approximately 10 participants with EoE without a CTD will be enrolled, all of whom will receive the Losartan intervention.
  Intervention: Drug: Losartan Potassium
• Experimental: EoE and CTD
  Approximately 5 participants with EoE and CTD will be enrolled, all of whom will receive the Losartan intervention.
  Intervention: Drug: Losartan Potassium

Inclusion Criteria:

1. Confirmed diagnosis of eosinophilic esophagitis.
2. Have been on a high dose proton pump inhibitor for at least 8 weeks prior to a diagnostic endoscopy of eosinophilic esophagitis without histologic resolution.
3. Agree to maintain the same diet throughout the duration of the study.

4. If participant is female: meet one of the following criteria:

   1. Is of non-childbearing potential (pre-menarchal or surgically sterile with documentation)
   2. Is of childbearing potential with a negative urine pregnancy test at screening.

Exclusion Criteria:

1. Past or planned cardiac surgeries.
2. Had an aortic root Z-score greater than 3 on a previous echocardiogram.
3. Have intolerance to the study agent such as angioedema, IgE-mediated allergy.
4. Have renal dysfunction with creatinine in excess of the upper normal limit for age.
5. Have another disorder that causes esophageal eosinophilia (e.g., hypereosinophilic syndrome, Churg Strauss vasculitis, eosinophilic granuloma, or a parasitic infection).
6. Diagnosed with hepatic insufficiency.
7. History of abnormal gastric or duodenal biopsy or documented gastrointestinal (GI) disorders (e.g., Celiac Disease, Crohn's disease or helicobacter pylori infection.), not including chronic gastritis, chronic duodenitis, mucosal eosinophilia or other eosinophilic gastrointestinal disorders.
8. Used anti-immunoglobulin E [IgE] mAb, anti-tumor necrosis factor [TNF] mAb, anti-IL-5 agents, or anti-IL-13 within the last six months.
9. Used methotrexate, cyclosporine, interferon-α, or other systemic immunosuppressive or immunomodulating agents within the last three months.
10. Have a history of a stricture during an endoscopy procedure that prevents passage of the endoscope.
11. Taking or plan to take an angiotensin II receptor blocker (ARB) therapy, angiotensin-converting enzyme inhibitor (ACEI), beta blocker therapy (BB), or calcium channel blocker at the screening visit or at any time during the study, or have you been taking any of these medications for the last three months.
12. If the participant is female: pregnant or nursing.
13. Taking any investigative drug or device study within the last 30 days.
14. Had participated in any investigative biologics study within the last three months prior to the study entry.
15. Taking or plan to take hydrochlorothiazide, warfarin, cimetidine, phenobarbital, rifampin, or fluconazole.
16. If the participant is female: using a medically accepted effective method of birth control.
17. Will be able to complete all study procedures including endoscopy.
18. Taking or plan to take potassium supplements or salt substitutes containing potassium.