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2015 ; 6
(3
): e82
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Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A
Systematic Review and Meta-Analysis
#MMPMID25809314
Chuang MY
; Chinnaratha MA
; Hancock DG
; Woodman R
; Wong GR
; Cock C
; Fraser RJ
Clin Transl Gastroenterol
2015[Mar]; 6
(3
): e82
PMID25809314
show ga
OBJECTIVES: Current guidelines recommend topical steroids as first-line treatment
for patients with eosinophilic esophagitis (EoE). However, the evidence for this
approach has been inconsistent in earlier reports. This meta-analysis aimed to
clarify the efficacy of topical steroid treatment in active EoE using updated
evidence. METHODS: CENTRAL, MEDLINE and EMBASE databases were searched for
randomized controlled trials (RCTs) published up to May 2014 that compared
topical steroids with control treatments for active EoE. Study bias was assessed
using the Cochrane Collaboration Tool, and outcomes were pooled using random
effects models. The primary outcome was the mean change in eosinophil counts.
Secondary outcomes were symptom responses and adverse events. RESULTS: In total,
seven RCTs (226 patients) were included. Topical steroids were associated with a
significant reduction in esophageal mucosal eosinophil counts compared with
control therapy although substantial heterogeneity between studies was observed
(weighted mean difference (WMD) -27.2, 95% confidence interval (CI) -45.3 to
-9.1, I(2)=56.2%). Subgroup analysis indicated the reduction in eosinophil counts
was only present in studies where a proton pump inhibitor (PPI) trial was used to
exclude other diagnoses (WMD -46.3, 95% CI -61.3 to -31.4, I(2)=0.0%).
Subdivision of studies on the use of a PPI trial also accounted for the majority
of heterogeneity among RCTs. No clear trends in symptom resolution were observed.
Eleven out of 127 patients who received topical steroids developed asymptomatic
esophageal candidiasis. CONCLUSIONS: These data provide updated high-quality
evidence that support current guidelines for first-line EoE treatment with
topical steroids after an initial PPI trial to exclude non-EoE pathologies
(PROSPERO ID: CRD42014008828).
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