title: Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis.
abstract: We performed a randomized trial to compare nebulized and viscous topical corticosteroid treatments for eosinophilic esophagitis (EoE). Subjects with incident EoE (n = 25) received budesonide 1 mg twice daily, either nebulized and then swallowed (NEB) or as an oral viscous slurry (OVB), for 8 weeks. Baseline eosinophil counts for the NEB and OVB groups were 101 and 83 (P = .62). Posttreatment counts were 89 and 11 (P = .02). The mucosal medication contact time, measured by scintigraphy, was higher for the OVB group than the NEB group (P < .005) and was inversely correlated with eosinophil count (R = -0.67; P = .001). OVB was more effective than NEB in reducing numbers of esophageal eosinophils in patients with EoE. OVB provided a significantly higher level of esophageal exposure to the therapeutic agent, which correlated with lower eosinophil counts.
authors.affiliation: Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. edellon@med.unc.edu
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.forename: Arif
authors.initials: A
authors.lastname: Sheikh
authors.forename: Olga
authors.initials: O
authors.lastname: Speck
authors.forename: Kimberly
authors.initials: K
authors.lastname: Woodward
authors.forename: Ann B
authors.initials: AB
authors.lastname: Whitlow
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Hores
authors.forename: Marija
authors.initials: M
authors.lastname: Ivanovic
authors.forename: Allen
authors.initials: A
authors.lastname: Chau
authors.forename: John T
authors.initials: JT
authors.lastname: Woosley
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madanick
authors.forename: Roy C
authors.initials: RC
authors.lastname: Orlando
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D019819:Budesonide / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004334:Drug Administration Schedule; D057765:Eosinophilic Esophagitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism; D004804:Eosinophils / Q000378:metabolism; D004947:Esophagus / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D058993:Oral Sprays; D011446:Prospective Studies; D011877:Radionuclide Imaging; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D058993:Oral Sprays; D019819:Budesonide