Oral viscous budesonide: a potential new therapy for eosinophilic esophagitis in children.
BACKGROUND
Eosinophilic esophagitis (EE) is a disorder characterized typically by pan-esophageal eosinophilia. We evaluate a palatable, long-acting topical corticosteroid preparation for the treatment of EE.


METHODS
This is a retrospective analysis of symptoms, endoscopic and histologic findings, efficacy, and safety of treatment in children with EE receiving oral viscous budesonide. Response to therapy was determined histologically by the number of eos/hpf. Patients were classified by histology into responders (0-7 eos/hpf), partial responders (8-23 eos/hpf), and nonresponders (>/=24 eos/hpf). A symptom score (max. 14) and an EE endoscopy score (max. 8) were used to compare data.


RESULTS
In 20 children (mean age 5.5 yr, median age 4.1 yr) the mean highest eosinophil count was 87 eos/hpf (range 30-170) before and 7 eos/hpf (range 0-50, P < 0.0001) after therapy. There were 16 (80%) responders, 1 partial responder, and 3 nonresponders. Commonest pretreatment symptoms were nausea, vomiting, pain, and heartburn. The mean symptom score fell from 4.4 to 0.8 (P < 0.0001) and the mean endoscopy score from 3.6 to 0.8 (P < 0.0001). No significant adverse events were reported. Morning cortisol levels were within normal limits.


CONCLUSIONS
Topical viscous budesonide is a safe and effective therapy for EE in young children.
Aceves
Seema S
SS
Division of Allergy and Immunology, Children's Hospital, San Diego, La Jolla, California, USA.
Bastian
John F
JF
Newbury
Robert O
RO
Dohil
Ranjan
R
D000284:Administration, Oral; D000293:Adolescent; D019819:Budesonide / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004802:Eosinophilia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D004941:Esophagitis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013535:Suspensions; D016896:Treatment Outcome; D014783:Viscosity
D005938:Glucocorticoids; D013535:Suspensions; D019819:Budesonide