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Vol. 44. Issue 4.
Pages 251-260 (April 2021)
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Vol. 44. Issue 4.
Pages 251-260 (April 2021)
Original article
DOI: 10.1016/j.gastre.2020.07.008
A meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic, clinical, and endoscopic outcome
Un metaanálisis de eficacia de los esteroides tópicos en la esofagitis eosinofílica desde la perspectiva del resultado histológico, clínico y endoscópico
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Li-xiao Haoa,1, Yi Lub,c,1, Tao Lia, Biao Gonga,
Corresponding author
gbercp616@163.com

Corresponding author.
a Department of Digestive Endoscopy, Shanghai Shuguang Hospital, Shanghai University of Chinese Medicine, Shanghai 201203, People's Republic of China
b Department of Gastrointestinal Endoscopy, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, People's Republic of China
c Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, People's Republic of China
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Tables (4)
Table 1. Basic characteristics of the selected studies.
Table 2. Definitions of outcome of the selected studies.
Table 3. Subgroup analysis results.
Table 4. Adverse events in each group.
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Abstract
Background

Swallowed topical steroids are a mainstay drug therapy for eosinophilic esophagitis (EoE), studies have demonstrated good histologic response, but with enormous discrepancy in clinical and endoscopic improvement. We conducted this meta-analysis to investigate the efficacy of topical steroids in EoE in histological, clinical and endoscopic improvement.

Methods

Several databases were searched from inception to August 1, 2019 for randomized controlled trials (RCTs) comparing topical steroids with placebo for EoE in the short-term. The outcomes of interest mainly included basic characteristics of the studies, histologic, clinical, endoscopic response rate and adverse events. The results were pooled together using Reviewer Manager 5.3.5 software, and inconsistency was quantified using I2 statistics.

Results

Nine studies were eventually selected. The results showed that topical steroids were effective in inducing histologic response compared with placebo for both complete (OR 35.82, 95% CI 14.98–85.64, P<0.0001; I2=0, P=0.72) and partial response (OR 28.44, 95% CI 8.56–94.47, P<0.0001; I2=70%, P=0.0009). Moreover, topical steroids were useful in gaining clinical response (OR 2.53, 95% CI 1.14–5.60, P=0.02; I2=60%, P=0.02) and endoscopic response (OR 3.51, 95% CI 1.47–8.36, P=0.005; I2=0, P=0.57). Generally, topical steroids are well tolerated. The most common adverse events are infections and infestations (59 cases).

Conclusion

Topical steroids were effective in inducing histological, clinical and endoscopic response in the short-term, and the adverse events were almost tolerable; however, we should interpret the result of clinical and endoscopic response with caution.

Keywords:
Eosinophilic esophagitis
Topical steroids
Fluticasone
Budesonide
Meta-analysis
Resumen
Antecedentes

Los esteroides tópicos tragados son una terapia farmacológica principal de la esofagitis eosinofílica (EoE). Algunos estudios han demostrado una buena respuesta histológica, aunque con gran discrepancia en la mejora clínica y endoscópica. Hemos realizado este metaanálisis para investigar la eficacia de los esteroides tópicos en EoE en la mejora histológica, clínica y endoscópica.

Métodos

Se buscaron varias bases de datos desde el inicio hasta el 1 de agosto de 2019 para ensayos controlados aleatorios comparando esteroides tópicos con placebo para EoE a corto plazo. Los resultados de interés incluyeron principalmente características básicas de los estudios, histológicas, clínicas, tasa de respuesta endoscópica y eventos adversos. Los resultados se agruparon mediante el software de Reviewer Manager 5.3.5, y la incoherencia se cuantificó mediante estadísticas I2.

Resultados

Nueve estudios fueron finalmente seleccionados. Los resultados mostraron que los esteroides tópicos fueron eficaces en la inducción de la respuesta histológica en comparación con placebo tanto para la respuesta completa (OR 35,82; IC 95%: 14,98-85,64; p<0,0001; I2 0, p=0,72) como para la parcial (OR 28,44; IC 95%: 8,56-94,47; p<0,0001; I2 70%, p=0,0009). Los esteroides tópicos también fueron útiles en la obtención de respuesta clínica (OR 2,53; IC 95%: 1,14-5,60; p=0,02; I2 60%; p=0,02) y respuesta endoscópica (OR 3,51; IC 95%: 1,47-8,36; p=0,005; I2 0; p=0,57). Los esteroides tópicos suelen ser bien tolerados. Los acontecimientos adversos más frecuentes son infecciones e infestaciones (59 casos).

Conclusión

Los esteroides tópicos fueron eficaces en la inducción de la respuesta histológica, clínica y endoscópica a corto plazo, y los eventos adversos fueron tolerables; sin embargo, debemos interpretar con precaución el resultado de la respuesta clínica y endoscópica.

Palabras clave:
Esofagitis eosinofílica
Esteroides tópicos
Fluticasona
Budesonida
Metaanálisis

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