Steroids therapy for eosinophilic esophagitis: Systematic review and meta-analysis

• Published in: Journal of digestive diseases Vol. 16; no. 8; pp. 431 - 442
• Main Authors: Tan, Nian Di, Xiao, Ying Lian, Chen, Min Hu
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.08.2015; Wiley Subscription Services, Inc
• Subjects: Confidence intervals; Endoscopy; eosinophilic esophagitis; Eosinophilic Esophagitis - blood; Eosinophilic Esophagitis - drug therapy; Eosinophils - pathology; Glucocorticoids - therapeutic use; Humans; Leukocyte Count; Meta-analysis; Proton Pump Inhibitors - therapeutic use; steroid; Steroids; systematic review; therapy; meta-analysis; systematic review; therapy; eosinophilic esophagitis; steroid
• ISSN: 1751-2972; 1751-2980
• DOI: 10.1111/1751-2980.12265

Objective We designed this systematic review and meta‐analysis aiming to clarify the advantage of steroid therapy compared with non‐steroid therapy for the treatment of eosinophilic esophagitis (EoE). Methods PubMed, EMBASE, Medline, ISI Web of Science and the Cochrane Database of Systematic Reviews were searched to identify relevant randomized controlled trials (RCTs) comparing steroid and non‐steroid therapy, and retrospective and prospective trials on steroid therapy for EoE. RevMan 5.2 was used for the analysis. Weighted mean difference and 95% confidence interval (CI) were estimated and pooled using meta‐analysis methods. Results Six RCTs including 193 participants fulfilled the inclusion criteria for meta‐analysis, and another two RCTs, three prospective and five retrospective trials were included in systematic review. Meta‐analysis showed that topical steroids significantly decreased the mean and peak esophageal eosinophils (EOS) count compared to non‐steroid therapy (MDmean = −23.41, 95% CImean −42.08–−4.73, P = 0.01 and MDpeak = −51.27, 95% CIpeak −78.62–−23.92, P = 0.0002). There were 14 trials showing the efficacy of steroids on decreasing the EOS count, 10 showing the amelioration of symptoms, and five showing endoscopic improvement. Only mild adverse events were reported for topical steroids. Conclusions Steroids are effective on decreasing the EOS count in EoE patients. Its value in ameliorating symptoms and endoscopic changes remains undetermined due to the lack of comparable criteria.