Cargando…
Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis
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 activ...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816205/ https://www.ncbi.nlm.nih.gov/pubmed/25809314 http://dx.doi.org/10.1038/ctg.2015.9 |
_version_ | 1782424673396457472 |
---|---|
author | Chuang, Ming-yu (Anthony) Chinnaratha, Mohamed A Hancock, David G Woodman, Richard Wong, Geoffrey R Cock, Charles Fraser, Robert JL |
author_facet | Chuang, Ming-yu (Anthony) Chinnaratha, Mohamed A Hancock, David G Woodman, Richard Wong, Geoffrey R Cock, Charles Fraser, Robert JL |
author_sort | Chuang, Ming-yu (Anthony) |
collection | PubMed |
description | 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). |
format | Online Article Text |
id | pubmed-4816205 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Nature Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-48162052016-04-14 Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis Chuang, Ming-yu (Anthony) Chinnaratha, Mohamed A Hancock, David G Woodman, Richard Wong, Geoffrey R Cock, Charles Fraser, Robert JL Clin Transl Gastroenterol Clinical/Narrative Review 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). Nature Publishing Group 2015-03 2015-03-26 /pmc/articles/PMC4816205/ /pubmed/25809314 http://dx.doi.org/10.1038/ctg.2015.9 Text en Copyright © 2015 American College of Gastroenterology http://creativecommons.org/licenses/by-nc-sa/4.0/ Clinical and Translational Gastroenterology is an open-access journal published by Nature Publishing Group. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/ |
spellingShingle | Clinical/Narrative Review Chuang, Ming-yu (Anthony) Chinnaratha, Mohamed A Hancock, David G Woodman, Richard Wong, Geoffrey R Cock, Charles Fraser, Robert JL Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis |
title | Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis |
title_full | Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis |
title_fullStr | Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis |
title_full_unstemmed | Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis |
title_short | Topical Steroid Therapy for the Treatment of Eosinophilic Esophagitis (EoE): A Systematic Review and Meta-Analysis |
title_sort | topical steroid therapy for the treatment of eosinophilic esophagitis (eoe): a systematic review and meta-analysis |
topic | Clinical/Narrative Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816205/ https://www.ncbi.nlm.nih.gov/pubmed/25809314 http://dx.doi.org/10.1038/ctg.2015.9 |
work_keys_str_mv | AT chuangmingyuanthony topicalsteroidtherapyforthetreatmentofeosinophilicesophagitiseoeasystematicreviewandmetaanalysis AT chinnarathamohameda topicalsteroidtherapyforthetreatmentofeosinophilicesophagitiseoeasystematicreviewandmetaanalysis AT hancockdavidg topicalsteroidtherapyforthetreatmentofeosinophilicesophagitiseoeasystematicreviewandmetaanalysis AT woodmanrichard topicalsteroidtherapyforthetreatmentofeosinophilicesophagitiseoeasystematicreviewandmetaanalysis AT wonggeoffreyr topicalsteroidtherapyforthetreatmentofeosinophilicesophagitiseoeasystematicreviewandmetaanalysis AT cockcharles topicalsteroidtherapyforthetreatmentofeosinophilicesophagitiseoeasystematicreviewandmetaanalysis AT fraserrobertjl topicalsteroidtherapyforthetreatmentofeosinophilicesophagitiseoeasystematicreviewandmetaanalysis |