A meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic,clinical, and endoscopic outcome |
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Authors: | Li-xiao Hao Yi Lu Tao Li Biao Gong |
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Institution: | 1. Department of Digestive Endoscopy, Shanghai Shuguang Hospital, Shanghai University of Chinese Medicine, Shanghai 201203, People''s Republic of China;2. Department of Gastrointestinal Endoscopy, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, People''s Republic of China;3. 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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Abstract: | BackgroundSwallowed 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.MethodsSeveral 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.ResultsNine 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).ConclusionTopical 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. |
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Keywords: | Eosinophilic esophagitis Topical steroids Fluticasone Budesonide Meta-analysis Esofagitis eosinofílica Esteroides tópicos Fluticasona Budesonida Metaanálisis |
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