Steroid Treatment of Eosinophilic Esophagitis in Adults

Topical steroid therapy has been used to treat eosinophilic esophagitis (EoE) for more than 15 years. We review the treatment trials of topical steroid therapy in adult patients with EoE. Currently, there is no commercially available preparation designed to deliver the steroid to the esophagus. Current regimens consist of swallowing steroid preparations designed for inhalation treatment for asthma. In the short term, steroids are associated with an approximately 15% to 25% incidence of asymptomatic esophageal candidiasis, but otherwise appear to be well tolerated.

Key points

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Currently, there is no commercially available preparation designed to deliver the steroid to the esophagus. Current regimens consist of swallowing steroid preparations designed for inhalation treatment for asthma.
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When used in proper dose, steroids lead to complete histologic responses in the range of 60% to 70% of patients and at least a partial histologic response in more than 90% of patients.
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Symptom response rates appear to be somewhat less than histologic rates, with at least a partial symptomatic response of only 60% to 75%.
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Maintenance therapy seems promising in one trial, but likely needs a higher dosage than 0.25 mg budesonide twice a day.
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In the short term, steroids are associated with about a 15% to 25% incidence of asymptomatic esophageal candidiasis, but otherwise appear to be well tolerated.

Open-labeled trials

The first report of topical steroid therapy in adult patients with eosinophilic esophagitis (EoE) was reported by Arora and colleagues in 2003 ( Table 1 ). In this open-labeled study, Arora and colleagues treated 21 adults with esophageal eosinophilic infiltration (EEI) and dysphagia. Patients were treated with 440 μg aerosolized swallowed fluticasone twice a day and all patients had a symptomatic response of their dysphagia to the treatment as accessed by a phone interview. Histologic follow-up was not obtained in this report.

Table 1

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