Steroids Therapy for Eosinophilic Esophagitis: Systematic Review and Meta-analysis.

AIM:

Eosinophilic esophagitis (EoE) is a disorder of the esophagus characterized by distinctive endoscopic and histologic features. Optimal treatment for EoE has not been defined. A systematic review and meta-analysis were performed to clarify the advantage of steroids therapy for EoE.

METHODS:

PubMed, EMBASE, Medline, ISI Wed of Science and the Cochrane Database of Systematic Reviews were searched to obtain relevant randomized controlled trials (RCTs) with comparison of steroids and non-steroids therapy, and retrospective and prospective trials on steroids therapy for EoE till March 2013. RevMan 5.2 was used for analysis.

RESULTS:

Six RCTs fulfilled inclusion criteria for meta-analysis, with 193 subjects included; And another 2 RCTs, 3 prospective and 5 retrospective trials fulfilled criteria of systematic review. Meta-analysis showed topical steroids significantly decreased the mean and peak esophageal eosinophils (eos) count compared to the non-steroids 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). The decease of mean eos was more pronounced in the adult group and when steroids compared to the placebo group (P=0.02 and P= 0.002 respectively). And the decrease of peak eos count remained significant independent of patient age, types of steroids (P＜0.05). There were 14 trials showing the efficacy of steroids on decreasing eos count, 10 trials showing improvement of symptoms, and 5 trials showing endoscopic improvement. Only mild adverse effects were reported for topical steroids.

CONCLUSIONS:

Steroids were effective on decreasing the mean and/ or peak eos count for EoE. Its value of improving symptoms and endoscopic changes was not yet determined due to lack of unified criteria.