Comparisons of Fluticasone to Budesonide in the Treatment of Eosinophilic Esophagitis

Albert, Dustin; Heifert, Theresa; Min, Steve B.; Maydonovitch, Corinne; Baker, Thomas P.; Chen, Yen-Ju; Moawad, Fouad J.

doi:10.1007/s10620-016-4110-9

Cited by 30 publications

(29 citation statements)

References 18 publications

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“…78 Since then, more than 10 controlled clinical trials in adult and pediatric patients with EoE have confirmed that swallowed topical corticosteroids, such as budesonide, fluticasone, and ciclesonide, are highly effective in resolving the symptoms and signs of EoE. 27,[78][79][80][81][82][83][84][85][86][87][88] One optimal method of delivery appears to be in a viscous form, shown by scintigraphy. 26 Proper dosing of steroids is essential in the treatment of adults with EoE.…”

Section: Corticosteroidsmentioning

confidence: 99%

Diagnosis and Treatment of Eosinophilic Esophagitis

2018

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Section: Corticosteroidsmentioning

confidence: 99%

Diagnosis and Treatment of Eosinophilic Esophagitis

2018

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“…Their activation sustains smooth muscle hyperplasia and hypertrophy in the oesophagus, indicating their critical role in the immunopathological process of EoE . Once the diagnosis is confirmed, there are two treatment approaches, elimination diet and corticosteroid treatment …”

Section: Introductionmentioning

confidence: 99%

High‐fat diet‐induced obesity worsens TH2 immune response and immunopathologic characteristics in murine model of eosinophilic oesophagitis

Silva

Oliveira

Ambrósio

et al. 2019

Clin Experimental Allergy

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Background: Eosinophilic oesophagitis (EoE) is an emergent chronic immunemediated disease of the oesophagus, which affects both children and adults. It is clinically characterized by dysphagia, food impaction and oesophageal eosinophilia.Epidemiological studies indicate that obesity can worsen allergic symptoms; however, its effect on EoE immunopathological response has not been evaluated yet. This study aimed to assess the effect of obesity on allergic inflammation and T helper-2 profile in an EoE experimental model. Methods:Obesity was induced by high-fat feeding. After 7 weeks of diet, male BALB/c mice were subcutaneously sensitized and orally challenged with OVA.Results: Obesity itself induced a significant mast cell and eosinophil accumulation in the oesophagus, trachea, gut and lung. After allergy induction, this number was higher, when compared to lean-allergic mice. Moreover, obese-allergic mice showed higher remodelling area, in the oesophagus, associated with higher IL-5 and TSLP mRNA expression.In contrast, FoxP3 and IL-10 were less expressed in comparison with lean-allergic mice.In addition, the amount of CD11c + MHCII + PDL1 + dendritic cells was reduced, while the number of CD11c + MHCII + CD80 + DCs and CD3 + CD4 + GATA 3 + IL-4 + cells was increased in obese-allergic mice in the spleen and lymph nodes when compared to lean-allergic mice. Conclusion:Obesity aggravated the immune histopathological characteristics in the EoE experimental model, which was associated with the reduction in the regulatory profile, and the increased inflammatory cells influx, related to the T H 2 profile.Altogether, the data provide new knowledge about obesity as a risk factor, worsening EoE symptoms, and contribute for future treatment strategies for this specific profile. K E Y W O R D Sallergy, eosinophilic oesophagitis, immune response, inflammation, obesity | 245 SILVA et AL.

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“…Collectively, the studies using budesonide appear to have a better response compared with fluticasone, although the two medications have never been compared head to head. A recent retrospective study did not find a significant difference between EoE patients treated with fluticasone versus budesonide . An open‐label randomized trial of 25 EoE patients compared the efficacy of nebulized budesonide to viscous budesonide and used nuclear scintigraphy to assess mucosal contact time between the two preparations .…”

Section: Current Therapies For Eoementioning

confidence: 99%

“…A recent retrospective study did not find a significant difference between EoE patients treated with fluticasone versus budesonide. 77 An open-label randomized trial of 25 EoE patients compared the efficacy of nebulized budesonide to viscous budesonide and used nuclear scintigraphy to assess mucosal contact time between the two preparations. 78 Patients randomized to viscous budesonide had a higher histologic response compared with nebulized budesonide, although it was not statistically significant (64% vs. 27%, P = 0.09).…”

Section: Corticosteroid Therapymentioning

confidence: 99%

Eosinophilic esophagitis: current perspectives from diagnosis to management

Moawad

Cheng

Schoepfer

et al. 2016

Annals of the New York Academy of Sciences

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Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immune disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. Although dense eosinophilia is the hallmark of EoE, other characteristic histologic features have been described that may help distinguish EoE from other competing diagnoses, although none are specific to EoE. One or more foods and, at times, environmental allergens trigger EoE. Left untreated, esophageal inflammation in EoE may lead to esophageal remodeling and stricture formation. Symptoms in EoE vary with age, as they relate to the progression of the disease from an inflammatory to a fibrostenotic phenotype over time. There are currently no U.S. Food and Drug Administration-approved therapies for EoE. Current options include various dietary-restriction therapies, topical corticosteroids, and esophageal dilations. Several emerging therapies aiming at restoring the esophageal barrier function or targeting various inflammatory cells or their mediators are under investigation.

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Comparisons of Fluticasone to Budesonide in the Treatment of Eosinophilic Esophagitis

Cited by 30 publications

References 18 publications

Diagnosis and Treatment of Eosinophilic Esophagitis

Diagnosis and Treatment of Eosinophilic Esophagitis

High‐fat diet‐induced obesity worsens TH2 immune response and immunopathologic characteristics in murine model of eosinophilic oesophagitis

Eosinophilic esophagitis: current perspectives from diagnosis to management

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