PMID- 25809314
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20150326
LR  - 20220409
IS  - 2155-384X (Print)
IS  - 2155-384X (Electronic)
IS  - 2155-384X (Linking)
VI  - 6
IP  - 3
DP  - 2015 Mar 26
TI  - Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A 
      Systematic Review and Meta-Analysis.
PG  - e82
LID - 10.1038/ctg.2015.9 [doi]
AB  - OBJECTIVES: 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).
FAU - Chuang, Ming-Yu Anthony
AU  - Chuang MY
AD  - Department of Medicine, Flinders Medical Centre, Bedford Park, South Australia, 
      Australia.
FAU - Chinnaratha, Mohamed A
AU  - Chinnaratha MA
AD  - School of Medicine, Flinders University, Bedford Park, South Australia, 
      Australia.
FAU - Hancock, David G
AU  - Hancock DG
AD  - School of Medicine, Flinders University, Bedford Park, South Australia, 
      Australia.
FAU - Woodman, Richard
AU  - Woodman R
AD  - School of Medicine, Flinders University, Bedford Park, South Australia, 
      Australia.
FAU - Wong, Geoffrey R
AU  - Wong GR
AD  - Department of Medicine, Flinders Medical Centre, Bedford Park, South Australia, 
      Australia.
FAU - Cock, Charles
AU  - Cock C
AD  - 1] School of Medicine, Flinders University, Bedford Park, South Australia, 
      Australia [2] Department of Gastroenterology, Flinders Medical Centre, Bedford 
      Park, South Australia, Australia.
FAU - Fraser, Robert Jl
AU  - Fraser RJ
AD  - 1] School of Medicine, Flinders University, Bedford Park, South Australia, 
      Australia [2] Department of Gastroenterology, Flinders Medical Centre, Bedford 
      Park, South Australia, Australia.
LA  - eng
PT  - Journal Article
DEP - 20150326
PL  - United States
TA  - Clin Transl Gastroenterol
JT  - Clinical and translational gastroenterology
JID - 101532142
PMC - PMC4816205
EDAT- 2015/03/27 06:00
MHDA- 2015/03/27 06:01
PMCR- 2015/03/01
CRDT- 2015/03/27 06:00
PHST- 2015/01/14 00:00 [received]
PHST- 2015/02/23 00:00 [accepted]
PHST- 2015/03/27 06:00 [entrez]
PHST- 2015/03/27 06:00 [pubmed]
PHST- 2015/03/27 06:01 [medline]
PHST- 2015/03/01 00:00 [pmc-release]
AID - ctg20159 [pii]
AID - 10.1038/ctg.2015.9 [doi]
PST - epublish
SO  - Clin Transl Gastroenterol. 2015 Mar 26;6(3):e82. doi: 10.1038/ctg.2015.9.