Journal article
Topical steroids in eosinophilic esophagitis: Systematic review and meta-analysis of placebo-controlled randomized clinical trials
Journal of gastroenterology and hepatology, Vol.31(6), pp.1111-1119
06/2016
DOI: 10.1111/jgh.13281
PMID: 26699695
Abstract
Eosinophilic esophagitis (EoE) is a clinicopathologic condition characterized by symptoms of esophageal dysfunction in the presence of eosinophil-predominant inflammation of esophageal mucosa. Topical steroids are recommended as first line pharmacologic therapy in EoE. We aimed to determine the efficacy of topical steroids in inducing histologic and clinical remission in children and adults with EoE.
We performed a systematic search of the MEDLINE, EMBASE, Scopus, and Cochrane library databases for studies investigating the efficacy of topical steroids in EoE. We collected data on the number of patients, dose and duration of therapy, complete and partial histological response, and clinical improvement. We performed meta-analysis of placebo-controlled randomized clinical trials using Review Manager version 5.2. We used funnel plots to evaluate for publication bias.
Five studies that included 174 patients with EoE were included in the meta-analysis. Topical fluticasone was administered in three studies involving 114 patients, and topical budesonide in two studies involving 60 patients. Patients treated with topical steroids, as compared with placebo, had higher complete histological remission (odds ratio [OR] 20.81, 95% confidence interval [CI] 7.03, 61.63) and partial histological remission (OR 32.20, 95% CI 6.82, 152.04). There was a trend towards improvement in clinical symptoms with topical steroids as compared with placebo but it did not reach statistical significance (OR 2.72, 95 %CI 0.90, 8.23).
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.
Details
- Title: Subtitle
- Topical steroids in eosinophilic esophagitis: Systematic review and meta-analysis of placebo-controlled randomized clinical trials
- Creators
- Arvind R Murali - Department of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAAshutosh Gupta - Departments of Gastroenterology and Hepatology and Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USABashar M Attar - Department of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, Rush University Medical Center, Chicago, Illinois, USAVenkatesh Ravi - Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USAPramoda Koduru - Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
- Resource Type
- Journal article
- Publication Details
- Journal of gastroenterology and hepatology, Vol.31(6), pp.1111-1119
- DOI
- 10.1111/jgh.13281
- PMID
- 26699695
- ISSN
- 0815-9319
- eISSN
- 1440-1746
- Language
- English
- Date published
- 06/2016
- Academic Unit
- Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984094559402771
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