Corticosteroids for Eosinophilic Esophagitis in Children: A Meta-analysis

Abstract

To assess the effects of topical corticosteroids on histologic and clinical outcomes of children with eosinophilic esophagitis.In this study, researchers analyzed data from 5 randomized controlled trials that included 206 patients.By using the Grading of Recommendations, Assessment, Development and Evaluation approach, the quality of evidence from these studies were methodologically assessed. Improvement in clinical and histologic indices were the primary outcomes.Data from the 5 studies revealed improvement in histology in 49.25% of corticosteroid-treated patients, as compared with 4.16% of placebo-treated children (risk ratio: 11.05 [confidence interval: 3.8 to 32.15]; P < .0001). Improvement in symptoms was seen in 33.6% of the corticosteroid group and 21.8% of the control group (risk ratio: 1.62 [confidence interval: 0.94 to 2.79]; P = .08). No major adverse effects were reported in these studies.Meta-analysis of data from 5 trials reveals statistically significant improvement in histologic responses but not in clinical responses to corticosteroid therapy in children with eosinophilic esophagitis.The meta-analysis is limited by having few studies, revealing the lack of consensus and heterogeneity in diagnosis of EoE. There was also notable variability in dietary management for EoE. More studies are needed to further understand the effects of topical corticosteroids. In addition, more sensitive clinical response indices or validated clinical scoring systems to would be beneficial in the evaluation of clinical responses.