Swallowed topical corticosteroids reduce the risk for long-lasting bolus impactions in eosinophilic esophagitis.

Abstract

BACKGROUND:

Long-lasting food impactions requiring endoscopic bolus removal occur frequently in patients with eosinophilic esophagitis (EoE) and harbor a risk for severe esophageal injuries. We evaluated whether treatment with swallowed topical corticosteroids is able to reduce the risk of occurrence of this complication.

METHODS:

We analyzed data from the Swiss EoE Cohort Study. Patients with yearly clinic visits, during which standardized assessment of symptoms, endoscopic, histologic, and laboratory findings was carried out, were included.

RESULTS:

A total of 206 patients (157 males) were analyzed. The median follow-up time was 5 years with a total of 703 visits (mean 3.41 visits/patient). During the follow-up period, 33 patients (16 % of the cohort) experienced 42 impactions requiring endoscopic bolus removal. We evaluated the following factors regarding the outcome 'bolus impaction' by univariate logistic regression modeling: swallowed topical corticosteroid therapy (OR 0.503, 95%-CI 0.255-0.993, P = 0.048), presence of EoE symptoms (OR 1.150, 95%-CI 0.4668-2.835, P = 0.761), esophageal stricture (OR 2.832, 95%-CI 1.508-5.321, P = 0.001), peak eosinophil count >10 eosinophils/HPF (OR 0.724, 95%-CI 0.324-1.621, P = 0.433), blood eosinophilia (OR 1.532, 95%-CI 0.569-4.118, P = 0.398), and esophageal dilation (OR 1.852, 95%-CI 1.034-3.755, P = 0.017). In the multivariate model, the following factors were significantly associated with bolus impaction: swallowed topical corticosteroid therapy (OR 0.411, 95%-CI 0.203-0.835, P = 0.014) and esophageal stricture (OR 2.666, 95%-CI 1.259-5.645, P = 0.01). Increasing frequency of use of swallowed topical steroids was associated with a lower risk for bolus impactions.

CONCLUSIONS:

Treatment of EoE with swallowed topical corticosteroids significantly reduces the risk for long-lasting bolus impactions.

• Authors: T Kuchen, A Straumann, E Safroneeva, Y Romero, C Bussmann, S Vavricka, P Netzer, A Reinhard, S Portmann, A M Schoepfer
• Journal: Allergy (Allergy) Vol. 69 Issue 9 Pg. 1248-54 (Sep 2014) ISSN: 1398-9995 [Electronic] Denmark
• PMID: 24894658 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Adrenal Cortex Hormones
• Androstadienes
• Anti-Inflammatory Agents
• Budesonide
• Fluticasone

Topics

• Adolescent
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Androstadienes (therapeutic use)
• Anti-Inflammatory Agents (therapeutic use)
• Budesonide (therapeutic use)
• Child
• Cohort Studies
• Eosinophilic Esophagitis (complications, drug therapy)
• Female
• Fluticasone
• Humans
• Male
• Middle Aged
• Risk Factors
• Young Adult