Topical steroids in eosinophilic esophagitis: Systematic review and meta‐analysis of placebo‐controlled randomized clinical trials

Murali, Arvind R.; Gupta, Ashutosh; Attar, Bashar M.; Ravi, Venkatesh; Koduru, Pramoda

doi:10.1111/jgh.13281

Cited by 116 publications

(82 citation statements)

References 34 publications

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“…Likewise, topical glucocorticoid therapy is effective in reducing eosinophil counts, epithelial hyperplasia, and subepithelial fibrosis [79]. Several rational, targeted therapies show promising results.…”

Section: Eoe Therapiesmentioning

confidence: 99%

Novel immunologic mechanisms in eosinophilic esophagitis

Caldwell

Paul

Rothenberg

2017

Current Opinion in Immunology

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Section: Eoe Therapiesmentioning

confidence: 99%

Novel immunologic mechanisms in eosinophilic esophagitis

Caldwell

Paul

Rothenberg

2017

Current Opinion in Immunology

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“…Results of some studies showed that eosinophilia can improve without a significant change in clinical symptoms. 26,32,33 …”

Section: Discussionmentioning

confidence: 99%

Effect of Topical Beclomethasone on Inflammatory Markers in Adults with Eosinophilic Esophagitis: A Pilot Study

Bhardwaj

Ishmael

Lehman

et al. 2017

Allergy�Rhinol (Providence)

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Background:Topical corticosteroids have proven efficacy in the treatment of eosinophilic esophagitis (EoE) and are considered the cornerstone of therapy.Objective:To evaluate the effect of topical beclomethasone dipropionate (BDP) therapy on clinical outcomes, esophageal eosinophilia, and other markers of inflammation in patients with EoE.Methods:Nine subjects with a biopsy-proven diagnosis of EoE were enrolled. In a cross-over design, the subjects were randomly assigned to a sequence of BDP and placebo. Treatment periods were 8 weeks, with a 4-week washout period. The subjects had endoscopic biopsies and blood tests at baseline and after each treatment period. They were instructed to maintain a diary of symptoms. Immuno-histochemical studies were performed for interleukins IL-4, IL-5, IL-13, granulocyte-macrophage colony-stimulating factor (GM-CSF), and transforming growth factor (TGF) beta. Reverse transcription polymerase chain reaction was performed for IL-3, IL-4, IL-5, IL-10, IL-13, IL-17F, IL-25, IL-33, chemokine ligands (CCL)2, CCL5, CCL11, GM-CSF, and TGF-beta levels. The mast cell tryptase (MCT) level was measured in esophageal tissues.Results:BDP led to a significantly larger decrease in esophageal eosinophilia compared with placebo, but there was no significant change in peripheral eosinophilia and high-sensitivity C-reactive protein between the two groups. The study was not powered enough for us to report a significant improvement in clinical symptoms. There was a significant decrease in tissue IL-13 and MCT levels from baseline to the end of treatment between the treatment and placebo groups. Mean fold decreases in cytokine expression between the baseline and treatment groups were observed for IL-17F, IL-25, CCL2, and CCL5.Conclusion:Treatment with topical BDP was associated with significant decrease in esophageal eosinophilia, MCT and IL-13. BDP is a potential alternative to fluticasone propionate and budesonide for treatment of EoE. Larger studies are needed to validate these findings.

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“…Early prospective trials of fluticasone with a small number of patients by Arora et al, and Remedios et al, showed universal improvement in symptoms [95,96]. Later studies appear to contradict these impressive results.…”

Section: Topical Glucocorticoidsmentioning

confidence: 98%

Eosinophilic Esophagitis: A Comprehensive Review

Nt¹

2016

J Hepatol Gastroint Dis

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Eosinophilic Esophagitis (EoE) has been the subject of intense research and study over the past few years, as incidence and prevalence has increased in the United States, especially in adults. The signs, symptoms and complications of EoE arise from a complex interplay of genetic predisposition and environmental exposure that is not understood well at this time. The disease causes significant morbidity in both physical and psychological areas, and these effects may become permanent in some cases where remodeling of the epithelium is present. Treatment at this time mainly focuses on diet, medication and endoscopic dilation. While none of these entities can accomplish all of the treatment goals, careful selection of patients based on symptoms and physical findings can alleviate many of the complications of the disease. In addition, this review attempts to cull data from adult studies if possible, as much of the studies that involved children did not translate well to adult patients.

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Topical steroids in eosinophilic esophagitis: Systematic review and meta‐analysis of placebo‐controlled randomized clinical trials

Abstract: Topical corticosteroids seem to be effective in inducing histological remission but may not have similar significant impact in improving clinical symptoms of EoE. Studies with large sample size are needed to uniformly validate symptom improvement in EoE.

Cited by 116 publications

References 34 publications

Novel immunologic mechanisms in eosinophilic esophagitis

Novel immunologic mechanisms in eosinophilic esophagitis

Effect of Topical Beclomethasone on Inflammatory Markers in Adults with Eosinophilic Esophagitis: A Pilot Study

Eosinophilic Esophagitis: A Comprehensive Review

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