S433 Topical Steroids for Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis

Abstract

Introduction: Eosinophilic Esophagitis (EoE) is the most common cause of food impaction with an estimated prevalence of 0.5-1 cases/1000 persons. Pharmacologic therapy consists of trial of PPI (Proton Pump Inhibitors) or topical steroids. Fluticasone and budesonide are the 2 most commonly used steroids and believed to decrease inflammation. The most recent meta-analysis with 2 studies concluded that budesonide viscous is the most effective steroid treatment for complete histologic remission. However, reporting analyses of one or 2 studies is not the best integration approach for a meta-analysis. Methods: We performed a literature search using PubMed and CINAHL from inception through December 22, 2019. The following search strategy was used (eosinophilic oesophagitis OR eosinophilic esophagitis) AND (steroid OR steroids). All articles were individually reviewed by 2 people and disagreements were agreed upon by consensus. We included clinical trials which reported data on clinical or histological change after the use of topical steroids. Results: In the absence of head-to-head comparisons of fluticasone and budesonide, we performed an indirect analysis with the available studies. The meta-analysis for budesonide versus placebo clinical remission showed that budesonide had increased odds for clinical remission (OR:6.15, 95% CI: 1.63, 23.15) with 5 of 6 studies favoring budesonide. Comparisons for budesonide versus placebo histological response showed that budesonide had increased odds for histological change (OR: 41.96, 95% CI: 13.09, 134.51) with all 5 studies favoring budesonide. Our comparisons for fluticasone versus placebo histological response showed that fluticasone had increased odds for histological change (OR: 26.37, 95% CI: 5.69, 122.29) with all 3 studies favoring fluticasone. Conclusion: Overall, we found that budesonide has increased odds for clinical remission and histological change. Fluticasone had increased odds for histological change. One of the limitations of our study is that there were no head-to-head comparison trials for comparison of budesonide with fluticasone. The trials included in our study were limited to the effect of budesonide or fluticasone to a placebo. Topical steroids including budesonide and fluticasone are effective for inducing histological change. Fluticasone is effective at bringing histological change but further trials are needed to study fluticasone and clinical response.Figure 1.: Flowchart of studies selection at each stageTable 1.: Data Extraction