Eosinophilic oesophagitis: a systematic review for otolaryngologists

Background Topical corticosteroids or six-food elimination diet are recommended as initial therapy for eosinophilic esophagitis (EoE). Aims We aimed to summarize published manuscripts that report outcomes of these therapies for EoE. Methods We performed a systematic review in MEDLINE, Web of Science, and Embase of published manuscripts describing topical fluticasone, topical budesonide, and six-food elimination diet as therapies for EoE. We conducted meta-analysis of symptom improvement and the change in peak mucosal eosinophil count, with heterogeneity between studies examined with meta-regression analysis. Results Systematic review yielded 51 articles that met inclusion criteria. Summary histologic response rates were 68.3% (95% prediction limits [PL] 16.2 to 96.0%) for fluticasone, 76.8% (95% PL 36.1 to 95.1%) for budesonide, and 69.0% (95% PL 31.9 to 91.4%) for six-food elimination diet. Corresponding decreases in eosinophil counts were 37.8 (95% PL 19.0 to 56.7), 62.5 (95% PL 125.6 to −0.67, and 44.6 (95% PL 26.5 to 62.7), respectively. Symptom response rates were 82.3% (95% PL 68.1 to 91.1%), 87.9% (95% PL 42.7 to 98.6%), and 87.3% (95% PL 64.5 to 96.3%), respectively. Meta-regression analyses decreased the initially large estimate of residual heterogeneity and suggested differences in histologic response rate associated with study populations’ baseline eosinophil count and age. Conclusions The literature describing topical corticosteroids and six-food elimination diet consists of small studies with diverse methods and population characteristics. Meta-analysis with meta-regression shows initial histologic and symptomatic response rates on the same order of magnitude for topical corticosteroids and six-food elimination diet, but heterogeneity of study designs prevent direct comparison of modalities.

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Six-Food Elimination Diet and Topical Steroids are Effective for Eosinophilic Esophagitis: A Meta-Regression

Cotton

Eluri

Wolf

et al. 2017

Dig Dis Sci

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Efficacy of Elimination Diets in Eosinophilic Esophagitis: A Systematic Review and Meta-analysis

Mayerhofer

Kavallar

Aldrian

et al. 2023

Clinical Gastroenterology and Hepatology

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Herbs for Eosinophilic, Mast-Cell, and Basophilic Diseases

Yarnell¹

2016

Alternative and Complementary Therapies

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Eosinophilic oesophagitis: a systematic review for otolaryngologists

Abstract: This paper systematically reviews the evidence base published on the epidemiology, clinical presentation, diagnosis, treatment and prognosis of eosinophilic oesophagitis, particularly as it relates to otolaryngology practice.

Cited by 3 publications

References 123 publications

Six-Food Elimination Diet and Topical Steroids are Effective for Eosinophilic Esophagitis: A Meta-Regression

Six-Food Elimination Diet and Topical Steroids are Effective for Eosinophilic Esophagitis: A Meta-Regression

Efficacy of Elimination Diets in Eosinophilic Esophagitis: A Systematic Review and Meta-analysis

Herbs for Eosinophilic, Mast-Cell, and Basophilic Diseases

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