Swallowed Topical Steroids Can Be Used as Maintenance Therapy for Patients With Eosinophilic Esophagitis

Swallowed topical corticosteroids are effective in inducing remission in adults with eosinophilic esophagitis (EoE). However, only short-term benefit has been shown. The majority of the patients (>90%) have symptomatic relapse after stopping topical steroid therapy.

A single-center retrospective observational study assessed 229 EoE patients treated with topical steroids. This included 175 males; mean age 39 years; and followed for a median of 5 years. The maintenance dose of swallowed topical corticosteroids used was 0.25 mg twice a day. Clinical remission was defined as absence of any EoE-attributed symptoms (dysphagia, retrosternal pain, and heartburn); endoscopic remission as no endoscopic signs of inflammation (white exudates, furrows, and edema); histologic remission as peak eosinophil count <15 eosinophils/high-power field; and complete remission as a combination of clinical, endoscopic, and histologic remission.  

At follow-up, a significantly larger number of patients who were still taking swallowed topical steroid therapy (compared to patients not taking steroids) were in clinical remission (31.0% vs 4.5%; P <.001), endoscopic remission (48.8% vs 17.8%; P <.001), histologic remission (44.8% vs 10.1%; P <.001), and complete remission (16.1% vs 1.3%; P <.001). Higher cumulative doses and longer duration of treatment with topical steroids were associated with higher proportions of clinical and complete remission. Esophageal candidiasis was observed at 2.7% of visits in patients on topical steroids.