Non-surgical interventions for eosinophilic oesophagitis.
BACKGROUND
Patients with eosinophilic oesophagitis (EO) present with difficulty swallowing, vomiting, regurgitation, chest and/or abdominal pain. People with EO frequently fail to respond to treatment with gastric acid suppressants or anti-reflux surgery.


OBJECTIVE
To evaluate the benefits and harms of medical interventions for eosinophilic oesophagitis.


METHODS
We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group trials register (The Cochrane Library Issue 1, 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February 2004) and EMBASE (1980 to February 2004).


METHODS
Randomised controlled trials were included if they compared a medical or dietary intervention for eosinophilic oesophagitis with a placebo or one medical intervention with another medical intervention.


METHODS
Two reviewers independently screened the title of abstracts.


RESULTS
No completed RCTs were found in the published literature. We found one abstract reporting preliminary data from an RCT (not completed) comparing oral prednisolone with topical (swallowed metered dose) fluticasone in children. In this study (50 children enrolled to date) healing rates of oesophagitis and symptom resolution with fluticasone were similar to those with prednisolone. For another ongoing RCT, comparing the efficacy of swallowed fluticasone with placebo for eosinophilic oesophagitis in males and females aged 3 to 21 years no results are available.


CONCLUSIONS
The lack of completed RCT's makes it impossible to compare the relative benefits and harms of the wide range of medical interventions currently used for treating EO. Published case series suggest that an elemental diet, oral steroids and topical steroids all offer some benefits. However, lack of a comparison group in these studies makes it impossible to evaluate the effect of these interventions.
Kukuruzovic
R H
RH
Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC, Australia, 3052.
Elliott
E E
EE
O'Loughlin
E V
EV
Markowitz
J E
JE
D000730:Androstadienes / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004802:Eosinophilia / Q000188:drug therapy*; D004941:Esophagitis / Q000188:drug therapy*; D000068298:Fluticasone; D006801:Humans; D011241:Prednisone / Q000627:therapeutic use
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone; D011241:Prednisone