title: Topical steroids in eosinophilic esophagitis: Systematic review and meta-analysis of placebo-controlled randomized clinical trials.
abstract: OBJECTIVE
  Eosinophilic esophagitis (EoE) is a clinicopathologic condition characterized by symptoms of esophageal dysfunction in the presence of eosinophil-predominant inflammation of esophageal mucosa. Topical steroids are recommended as first line pharmacologic therapy in EoE. We aimed to determine the efficacy of topical steroids in inducing histologic and clinical remission in children and adults with EoE.
  
  
  METHODS
  We performed a systematic search of the MEDLINE, EMBASE, Scopus, and Cochrane library databases for studies investigating the efficacy of topical steroids in EoE. We collected data on the number of patients, dose and duration of therapy, complete and partial histological response, and clinical improvement. We performed meta-analysis of placebo-controlled randomized clinical trials using Review Manager version 5.2. We used funnel plots to evaluate for publication bias.
  
  
  RESULTS
  Five studies that included 174 patients with EoE were included in the meta-analysis. Topical fluticasone was administered in three studies involving 114 patients, and topical budesonide in two studies involving 60 patients. Patients treated with topical steroids, as compared with placebo, had higher complete histological remission (odds ratio [OR] 20.81, 95% confidence interval [CI] 7.03, 61.63) and partial histological remission (OR 32.20, 95% CI 6.82, 152.04). There was a trend towards improvement in clinical symptoms with topical steroids as compared with placebo but it did not reach statistical significance (OR 2.72, 95 %CI 0.90, 8.23).
  
  
  CONCLUSIONS
  Topical corticosteroids seem to be effective in inducing histological remission but may not have similar significant impact in improving clinical symptoms of EoE. Studies with large sample size are needed to uniformly validate symptom improvement in EoE.
authors.affiliation: Department of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: Arvind R
authors.initials: AR
authors.lastname: Murali
authors.affiliation: Departments of Gastroenterology and Hepatology and Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Bashar M
authors.initials: BM
authors.lastname: Attar
authors.affiliation: Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Ravi
authors.affiliation: Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA.
authors.forename: Pramoda
authors.initials: P
authors.lastname: Koduru
mesh_terms: D000287:Administration, Topical; D019819:Budesonide / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000071041:Esophageal Mucosa / Q000187:drug effects / Q000473:pathology; D004947:Esophagus / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D000068298:Fluticasone / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D013256:Steroids; D019819:Budesonide; D000068298:Fluticasone
keywords: budesonide; dysphagia; eosinophilic esophagitis; fluticasone; topical steroids