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Oral Viscous Budesonide

A Potential New Therapy for Eosinophilic Esophagitis in Children

Aceves, Seema S., M.D., Ph.D.1,4; Bastian, John F., M.D.1,4; Newbury, Robert O., M.D.2; Dohil, Ranjan, M.D.3,4

American Journal of Gastroenterology: October 2007 - Volume 102 - Issue 10 - p 2271–2279

BACKGROUND Eosinophilic esophagitis (EE) is a disorder characterized typically by pan-esophageal eosinophilia. We evaluate a palatable, long-acting topical corticosteroid preparation for the treatment of EE.

STUDY DESIGN This is a retrospective analysis of symptoms, endoscopic and histologic findings, efficacy, and safety of treatment in children with EE receiving oral viscous budesonide. Response to therapy was determined histologically by the number of eos/hpf. Patients were classified by histology into responders (0–7 eos/hpf), partial responders (8–23 eos/hpf), and nonresponders (≥24 eos/hpf). A symptom score (max. 14) and an EE endoscopy score (max. 8) were used to compare data.

RESULTS In 20 children (mean age 5.5 yr, median age 4.1 yr) the mean highest eosinophil count was 87 eos/hpf (range 30–170) before and 7 eos/hpf (range 0–50, P < 0.0001) after therapy. There were 16 (80%) responders, 1 partial responder, and 3 nonresponders. Commonest pretreatment symptoms were nausea, vomiting, pain, and heartburn. The mean symptom score fell from 4.4 to 0.8 (P < 0.0001) and the mean endoscopy score from 3.6 to 0.8 (P < 0.0001). No significant adverse events were reported. Morning cortisol levels were within normal limits.

CONCLUSIONS Topical viscous budesonide is a safe and effective therapy for EE in young children.

Divisions of 1Allergy and Immunology, 2Pathology, and 3Gastroenterology, Children's Hospital, San Diego, La Jolla, California; and 4Department of Pediatrics, University of California, San Diego, La Jolla, California

Reprint requests and correspondence: Ranjan Dohil, M.D., UCSD Medical Center, Hillcrest, 200 West Arbor Dr. San Diego, CA 92103-8450.

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CONFLICT OF INTEREST Guarantor of the article: Dr. Ranjan Dohil, M.D.

Specific author contributions: The manuscript was written by Dr. Ranjan Dohil, Dr. Seema S. Aceves, and Dr. John F. Bastian. Dr. Robert O. Newbury provided all pathology data.

Financial support: Dr. Aceves receives salary support from the Education and Research Trust Young Investigator Grant from the American Academy of Allergy, Asthma, and Immunology. No other contributor has received salary support for this endeavor.

Potential competing interests: None.

Received January 25, 2007; accepted April 22, 2007.

© The American College of Gastroenterology 2007. All Rights Reserved.
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