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Comparisons of Fluticasone to Budesonide in the Treatment of Eosinophilic Esophagitis

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Abstract

Background

Topical steroids are first-line treatment agents for eosinophilic esophagitis; however, some studies have demonstrated modest efficacy in inducing histologic remission.

Aims

The aim of this study was to determine response to two topical steroids (fluticasone and budesonide), compare their efficacy, and examine patient characteristics which could predict non-response to topical steroids.

Methods

We performed a retrospective review of an established EoE registry. Inclusion criteria were patients >1 year of age who were diagnosed with EoE as defined by the most recent consensus guidelines. All patients were treated with an 8-week course of either swallowed fluticasone or viscous budesonide. Responders were defined as achieving <15 eosinophils per high-power field (eos/hpf) in both proximal and distal esophageal biopsies. Demographic, clinical, endoscopic, and histologic features were examined.

Results

The study cohort included 75 EoE patients with a median age of 33 years (range 2–64 years), 71 % adults, 84 % male, and 76 % Caucasian. Overall histologic response rate to topical steroids was 51 %, while clinical response was 71 %. There was no significant differences in histologic response to treatment between children and adults (68 vs. 44 %, p = 0.111). There was no significant difference in response between males and females (47 vs. 73 %, p = 0.191) and between the two types of steroids (48 vs. 56 %, p = 0.632). Responders and non-responders were similar in clinical presentation and baseline endoscopic findings. Following treatment, responders had significantly less peak proximal (4.0 ± 4.4 vs. 46 ± 53, p < 0.001) and distal eosinophil counts (3.5 ± 3.8 vs. 60 ± 47, p < 0.001) compared to non-responders. There were no predictors of response to steroids identified.

Conclusions

Histologic response to treatment was observed in approximately half the cohort, while more than two-thirds experienced clinical response to topical steroids. Response was similar between fluticasone and budesonide. Given the lack of differences in clinical presentation or endoscopic features, predictors of non-response were not seen.

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Abbreviations

EoE:

Eosinophilic esophagitis

PPI:

Proton-pump inhibitor

eos/hpf:

Eosinophils per high-powered field

PPI-REE:

Proton-pump inhibitor-responsive esophageal eosinophilia

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Author contributions

Dustin M. Albert, Theresa A. Heifert, Steve B. Min, and Fouad J. Moawad substantially contributed to conception and design, acquisition of data, analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; and approved the final version to be published. Corinne L. Maydonovitch and Thomas P. Baker analyzed and interpreted the data; drafted the article or revised it critically for important intellectual content; and approved the final version to be published. Yen-Ju Chen acquired the data, drafted the article or revised it critically for important intellectual content, and approved the final version to be published.

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Authors and Affiliations

  1. Gastroenterology Service, Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA

    Dustin Albert, Corinne L. Maydonovitch, Yen-Ju Chen & Fouad J. Moawad

  2. Gastroenterology Service, Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Theresa A. Heifert & Steve B. Min

  3. Department of Pathology, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Thomas P. Baker

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  1. Dustin Albert
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  2. Theresa A. Heifert
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Correspondence to Fouad J. Moawad.

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Albert, D., Heifert, T.A., Min, S.B. et al. Comparisons of Fluticasone to Budesonide in the Treatment of Eosinophilic Esophagitis. Dig Dis Sci 61, 1996–2001 (2016). https://doi.org/10.1007/s10620-016-4110-9

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  • DOI: https://doi.org/10.1007/s10620-016-4110-9

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