title: Update on topical steroid therapy for eosinophilic esophagitis.
abstract: This review aims to summarize evolving evidence on topical steroid (TS) therapy for eosinophilic esophagitis (EoE). Currently, we still use "off-label" TS, originally designed for bronchial or intranasal delivery. Direct oral administration (i.e., oral viscous budesonide) achieves better histological results than the aerosolized swallowed route, due to longer mucosal contact time. High-dose fluticasone (880 μg bid) has recently shown higher cure rates in children and adults. Steroid resistance is present in around 25-40% of patients. Nonetheless, novel steroid formulations specifically designed for EoE have exhibited outstanding preliminary results (cure rates around 100%). Narrow caliber esophagus (<13 mm) might explain persistent dysphagia despite histological remission on TS therapy and endoscopic dilation should be considered. TS are currently considered safe drugs, but we lack long-term safety data. Maintenance anti-inflammatory therapy is recommended in all patients to prevent disease recurrence and esophageal fibrotic remodeling, although this strategy is yet to be defined.
authors: Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain. Electronic address: xavi_molina@hotmail.com.
authors: Javier
authors: J
authors: Molina-Infante
authors: Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.
authors: Alfredo J
authors: AJ
authors: Lucendo
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000336:Aerosols; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D004351:Drug Resistance; D057765:Eosinophilic Esophagitis / Q000188:drug therapy*; D005355:Fibrosis / Q000517:prevention & control; D006801:Humans; D036501:Metered Dose Inhalers; D056687:Off-Label Use; D014677:Pharmaceutical Vehicles; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
chemical_list: D000305:Adrenal Cortex Hormones; D000336:Aerosols; D000893:Anti-Inflammatory Agents; D014677:Pharmaceutical Vehicles
keywords: Budesonida; Budesonide; Corticoides; Corticosteroids; Eosinophilic esophagitis; Esofagitis eosinofílica; Fluticasona; Fluticasone propionate