P0289 - Do Topical Corticosteroids Induce Histologic Remission and Improve Clinical Symptoms in Eosinophilic Esophagitis? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Sami Ghazaleh, MD¹, Dana Ghazaleh, MD², Wasef Sayeh, MD¹, Justin Chuang, MD¹, Amna Iqbal, MD¹, Dipen Patel, MD, MBA¹, Christian Nehme, MD¹, Sehrish Malik, MD³, Ziad Abuhelwa, MD¹, Saif-Eddin Malhas, MD¹, Azizullah Beran, MD³, Sachit Sharma, MD⁴, Muhammad Aziz, MD³, Ali Nawras, MD^3
1University of Toledo, Toledo, OH; ²An-Najah National University, Coralville, IA; ³University of Toledo Medical Center, Toledo, OH; ⁴Virginia Commonwealth University Health System, Richmond, VA

Introduction: Eosinophilic esophagitis is a chronic esophageal disease characterized histologically by eosinophil-predominant inflammation and clinically by symptoms related to esophageal dysfunction. The management of the disease commonly involves elimination diet, acid suppression, topical corticosteroids, and esophageal dilation. A few studies have investigated the benefit of topical corticosteroids in inducing histologic remission, but the effect on clinical symptoms remains unclear because of paucity of studies.

Methods: We conducted a systematic review and meta-analysis of studies that investigated the efficacy and safety of topical corticosteroids compared with placebo in eosinophilic esophagitis. We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through October 18, 2020. We considered randomized controlled trials, cohort studies, case-control studies, and case series. We excluded abstracts, animal studies, case reports, reviews, editorials, and letters to editors. From each study, we collected the number of patients who received topical corticosteroids or placebo. Our primary outcome was histologic remission, which was defined differently by each study. The most consistent definition was >90% reduction in eosinophils. Other outcomes were symptomatic clinical improvement and the occurrence of oral or esophageal candidiasis. The random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). A p-value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I² index.

Results: Nine randomized controlled trials involving 483 patients were included in the meta-analysis. Compared to placebo, patients who received steroids were more likely to achieve histologic remission (RR 12.50, 95% CI 6.04 – 25.88, p < 0.00001, I² = 0%) and report symptomatic clinical improvement (RR 1.84, 95% CI 1.02 – 3.32, p = 0.04, I² = 64%). Oral or esophageal candidiasis was more likely to occur in patients who received steroids (RR 4.31, 95% CI 1.53 – 12.18, p = 0.006, I² = 0%).

Discussion: Our meta-analysis demonstrated that topical corticosteroids were more effective than placebo in achieving histologic remission and improving clinical symptoms. However, they are more likely to cause oral or esophageal candidiasis. Future studies should investigate the effect of topical corticosteroids on endoscopic remission and other side effects.


Figure: Forest plot comparing topical steroids and placebo in terms of (a) histologic remission, (b) symptomatic improvement, and (c) oral or esophageal candidiasis


Disclosures:
Sami Ghazaleh indicated no relevant financial relationships.
Dana Ghazaleh indicated no relevant financial relationships.
Wasef Sayeh indicated no relevant financial relationships.
Justin Chuang indicated no relevant financial relationships.
Amna Iqbal indicated no relevant financial relationships.
Dipen Patel indicated no relevant financial relationships.
Christian Nehme indicated no relevant financial relationships.
Sehrish Malik indicated no relevant financial relationships.
Ziad Abuhelwa indicated no relevant financial relationships.
Saif-Eddin Malhas indicated no relevant financial relationships.
Azizullah Beran indicated no relevant financial relationships.
Sachit Sharma indicated no relevant financial relationships.
Muhammad Aziz indicated no relevant financial relationships.
Ali Nawras indicated no relevant financial relationships.


Sami Ghazaleh, MD¹, Dana Ghazaleh, MD², Wasef Sayeh, MD¹, Justin Chuang, MD¹, Amna Iqbal, MD¹, Dipen Patel, MD, MBA¹, Christian Nehme, MD¹, Sehrish Malik, MD³, Ziad Abuhelwa, MD¹, Saif-Eddin Malhas, MD¹, Azizullah Beran, MD³, Sachit Sharma, MD⁴, Muhammad Aziz, MD³, Ali Nawras, MD³. P0289 - Do Topical Corticosteroids Induce Histologic Remission and Improve Clinical Symptoms in Eosinophilic Esophagitis? A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.