title: Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Current guidelines recommend topical steroids as first-line treatment for patients with eosinophilic esophagitis (EoE). However, the evidence for this approach has been inconsistent in earlier reports. This meta-analysis aimed to clarify the efficacy of topical steroid treatment in active EoE using updated evidence.
  
  
  METHODS
  CENTRAL, MEDLINE and EMBASE databases were searched for randomized controlled trials (RCTs) published up to May 2014 that compared topical steroids with control treatments for active EoE. Study bias was assessed using the Cochrane Collaboration Tool, and outcomes were pooled using random effects models. The primary outcome was the mean change in eosinophil counts. Secondary outcomes were symptom responses and adverse events.
  
  
  RESULTS
  In total, seven RCTs (226 patients) were included. Topical steroids were associated with a significant reduction in esophageal mucosal eosinophil counts compared with control therapy although substantial heterogeneity between studies was observed (weighted mean difference (WMD) -27.2, 95% confidence interval (CI) -45.3 to -9.1, I(2)=56.2%). Subgroup analysis indicated the reduction in eosinophil counts was only present in studies where a proton pump inhibitor (PPI) trial was used to exclude other diagnoses (WMD -46.3, 95% CI -61.3 to -31.4, I(2)=0.0%). Subdivision of studies on the use of a PPI trial also accounted for the majority of heterogeneity among RCTs. No clear trends in symptom resolution were observed. Eleven out of 127 patients who received topical steroids developed asymptomatic esophageal candidiasis.
  
  
  CONCLUSIONS
  These data provide updated high-quality evidence that support current guidelines for first-line EoE treatment with topical steroids after an initial PPI trial to exclude non-EoE pathologies (PROSPERO ID: CRD42014008828).
authors: Department of Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia.
authors: Ming-Yu Anthony
authors: MY
authors: Chuang
authors: School of Medicine, Flinders University, Bedford Park, South Australia, Australia.
authors: Mohamed A
authors: MA
authors: Chinnaratha
authors: School of Medicine, Flinders University, Bedford Park, South Australia, Australia.
authors: David G
authors: DG
authors: Hancock
authors: School of Medicine, Flinders University, Bedford Park, South Australia, Australia.
authors: Richard
authors: R
authors: Woodman
authors: Department of Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia.
authors: Geoffrey R
authors: GR
authors: Wong
authors: 1] School of Medicine, Flinders University, Bedford Park, South Australia, Australia [2] Department of Gastroenterology, Flinders Medical Centre, Bedford Park, South Australia, Australia.
authors: Charles
authors: C
authors: Cock
authors: 1] School of Medicine, Flinders University, Bedford Park, South Australia, Australia [2] Department of Gastroenterology, Flinders Medical Centre, Bedford Park, South Australia, Australia.
authors: Robert Jl
authors: RJ
authors: Fraser