No Maintenance, No Gain in Long-term Treatment of Eosinophilic Esophagitis

Dellon, Evan S.

doi:10.1016/j.cgh.2018.07.038

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…[6][7][8] Reducing the occurrence of relapse and potential fibrostenotic complications are important components of maintenance therapy. 9 Clinical guidelines recommend continuing topical corticosteroids for patients in remission after short-term therapy. 2,3,10 However, there is a paucity of data on long-term therapy with swallowed topical corticosteroids through randomized controlled trials, and limited guidance on the optimal dose regimen for maintenance therapy in EoE.…”

Section: Discussionmentioning

confidence: 99%

“…3 Our findings substantiate the limited evidence that improvements in disease outcomes are impacted on treatment withdrawal. 9,17,18 Previous work showed that long-term treatment with topical corticosteroids is more effective than placebo in maintaining histologic and clinical remission in EoE. 18 Maintaining histologic response has been correlated with a reduced requirement for endoscopic dilation in adult patients.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Treatment of Eosinophilic Esophagitis With Budesonide Oral Suspension

Collins

Morey

Goodwin

et al. 2022

Clinical Gastroenterology and Hepatology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Treatment of Eosinophilic Esophagitis With Budesonide Oral Suspension

Collins

Morey

Goodwin

et al. 2022

Clinical Gastroenterology and Hepatology

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“…Since the deficient/ insufficient levels of 25(OH)D directly influence the inflammatory state generated by the immune system (26) and since EoE is a disease characterized by chronic esophageal inflammation (11) , the continuous monitoring of these patients should include 25(OH)D levels. This should include orienting patients to have correct exposure to the sun for a sufficient amount of time, with the use of appropriate clothing, to trigger the correct production of vitamin D.…”

Section: Discussionmentioning

confidence: 99%

“…Eosinophilic esophagitis (EoE) is a chronic disease, characterized histologically by predominantly eosinophilic inflammation (11) , and fibrosis can also be observed (9) . It has a prevalence of 37 per 100,000 pediatric patients (12) .…”

mentioning

confidence: 99%

Case-Control Study on Vitamin D Status in Children and Adolescents With Eosinophilic Esophagitis

Teixeira

Linden

Lomazi

et al. 2020

Arq. Gastroenterol.

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BACKGROUND: Vitamin D is an essential fat-soluble steroid hormone and vitamin D deficiency is a global public health problem especially among children and adolescents. Factors such as the low intake of vitamin D-rich food sources, poor absorption and less exposure to the sun influence this outcome. Vitamin D has an anti-inflammatory effect in the body by promoting regulatory T cell differentiation as well as recovering T helper 17 cell response and secretion of anti-inflammatory cytokines. Eosinophilic esophagitis (EoE) is a chronic disease, histologically characterized by predominantly eosinophilic inflammation. The most common therapeutic approaches are allergen-eliminating diets, such as excluding cow’s milk, egg, soy, wheat, peanuts and seafood, or more specific dietary restrictions. OBJECTIVE: To verify the serum levels of vitamin D in children and adolescents with eosinophilic esophagitis on a restricted food diet and to analyze their association with nutritional status, consumption of different food sources, exposure to the sun and skin color. METHODS: Case-control study conducted in the city of Campinas-SP, Brazil, in which included patients were aged 2 to 18 years old, and those diagnosed with eosinophilic esophagitis was referred to as the case group (n=15), meanwhile a control group (n=17) was also formed. Epidemiological data, nutritional status, data on vitamin D intake (24-hour recall - performed only by EoE patients - and self-reported intake of vitamin D food sources: milk and dairy products, canned tuna and sardines, Bull’s liver, chicken eggs - applied in both groups), and daily time of sun exposure (≥30 min or ≤30 min) were recorded. The samples were collected for serum levels of 25-hydroxy-vitamin D, where sufficiency levels >30 ng/mL were considered, insufficiency 21 to 30 ng/mL, deficiency <20 ng/mL. RESULTS: There was a higher frequency of vitamin D insufficiency/ deficiency in the Eosinophilic Esophagitis group (P=0.035), even with longer sun exposure (P= 0.035). Skin color was not associated with lower levels of vitamin D in both groups studied. No difference was found in nutritional status between the groups. CONCLUSION: The present study demonstrated a higher frequency of inadequate/ deficient levels of vitamin D in children and adolescents with EoE on a restricted diet. When necessary, serum levels should be investigated and correct exposure to the sun should be encouraged, with special attention to the recommended guidelines, time spent in the sun and the appropriate clothing for correct absorption. Since exposure for more than 30 minutes in the sun does not appear to have provided a protective effect in the EoE group, even in a region with high levels of solar radiation. There was a significant difference only in the consumption of cow’s milk between the case and control groups, demonstrating the low adherence to the restriction diet by the case group. No association was found between serum 25 hydroxyvitamin D levels and nutritional status. Moreover, no association regarding the adequate or inadequate status of 25 hydroxyvitamin D and the consumption vitamin D-rich foods was identified. Multicentered studies with a larger number of cases should be performed to assess serum 25 hydroxyvitamin D levels and associated factors in pediatric patients with EoE.

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“…Histologic EoE disease activity may not correlate with clinical symptoms, but histologically active disease may still result in the progression of fibrosis and adverse outcomes such as esophageal strictures and food impactions [2]. Increasingly, evidence has shown that EoE maintenance therapy is needed to achieve histologic remission and halt the progression of fibrostenosis [13,15,16]. Further commentary has emphasized the need to consider therapy for EoE in the context of real-world practice as, currently, assessing and modifying treatment often necessitates monitoring EoE disease activity via repeat EGD(s) with biopsy [17].…”

Section: Introductionmentioning

confidence: 99%

Improved Outcomes in Eosinophilic Esophagitis with Higher Medication Possession Ratio

Kolasinski,

Pasman,

Nylund

et al. 2024

Medicines

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Eosinophilic esophagitis (EoE) disease activity can be caused by treatment non-adherence. Medication possession ratio (MPR) is an established metric of medication adherence. A higher MPR correlates with better outcomes in several chronic diseases, but MPR has not been investigated with respect to EoE. A retrospective cohort study was performed using an established EoE registry for the years 2005 to 2020. Treatment periods were identified, MPRs were calculated, and medical records were assessed for histologic remission (<15 eos/hpf), dysphagia, food impaction, stricture occurrence, and esophageal dilation that corresponded to each treatment period. In total, 275 treatment periods were included for analysis. The MPR in the histologic remission treatment period group was 0.91 (IQR 0.63–1) vs. 0.63 (IQR 0.31–0.95) for the non-remission treatment period group (p < 0.001). The optimal MPR cut-point for histologic remission was 0.7 (Sen 0.66, Spec 0.62, AUC 0.63). With MPRs ≥ 0.7, there were significantly increased odds of histologic remission (odds ratio 3.05, 95% confidence interval 1.79–5.30) and significantly decreased odds of dysphagia (OR 0.27, 95% CI 0.15–0.45), food impaction (OR 0.26, 95% CI 0.11–0.55), stricture occurrence (OR 0.52 95% CI 0.29–0.92), and esophageal dilation (OR 0.29, 95% CI 0.15–0.54). Assessing MPR before repeating an esophagogastroduodenoscopy may decrease unnecessary procedures in the clinical management of eosinophilic esophagitis.

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No Maintenance, No Gain in Long-term Treatment of Eosinophilic Esophagitis

Cited by 5 publications

References 29 publications

Long-Term Treatment of Eosinophilic Esophagitis With Budesonide Oral Suspension

Long-Term Treatment of Eosinophilic Esophagitis With Budesonide Oral Suspension

Case-Control Study on Vitamin D Status in Children and Adolescents With Eosinophilic Esophagitis

Improved Outcomes in Eosinophilic Esophagitis with Higher Medication Possession Ratio

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