Adrenal insufficiency exists for both swallowed budesonide and fluticasone propionate in the treatment of eosinophilic esophagitis

Harel, Shira; Hursh, Brenden E.; Chan, Edmond S.; Avinashi, Vishal; Panagiotopoulos, Constadina

doi:10.1016/j.jpeds.2016.02.056

Cited by 6 publications

(6 citation statements)

References 2 publications

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“…Maintaining the lowest effective dose of medication possible in EoE makes intuitive sense given the potential long-term side effects of corticosteroids (e.g. adrenal suppression, oropharyngeal candidiasis) [51] and the unknown safety profile of high-dose proton pump inhibitors. Proton pump inhibitors may be reduced from twice daily ‘high-dose’ to daily dosing at approved dosing levels with maintenance of histological remission in 75–85% of patients at up to 1 year of follow-up[52, 53].…”

Section: Maintenance Therapy and Long-term Outcomesmentioning

confidence: 99%

The role of maintenance therapy in eosinophilic esophagitis: who, why, and how?

Philpott

Dellon

2017

J Gastroenterol

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In patients with eosinophilic esophagitis (EoE) who do not respond to proton pump inhibitors, initial antiinflammatory/anti-eosinophilic treatment is with either topical corticosteroids or dietary elimination. A large body of literature supports the efficacy of these approaches, with histologic response rates in the 50-90% range for steroids and 70% range for the six-food elimination diet. However, these studies are almost all short-term and data evaluating long-term safety and efficacy of either treatment are limited. Nevertheless, because EoE is chronic, symptomatic, endoscopic, and histologic disease activity recurs when successful treatments are stopped. An emerging body of data also suggest that left untreated, persistent eosinophilic esophageal inflammation may progress to fibrostenosis over time. Therefore, maintenance therapy in EoE is intuitively attractive. This paper reviews the rationale for maintenance treatment in EoE, the available long-term pharmacologic and dietary response data for EoE, and discusses who may benefit the most from ongoing treatment. While all patients with EoE can be offered maintenance treatment, this option should be strongly recommended in patients with severe disease phenotypes or complications, including malnutrition or failure to thrive, esophageal fibrostenosis, strictures requiring dilation, recurrent food bolus impaction, history of perforation, and symptoms that recur quickly after treatment discontinuation. In all EoE patients, regular follow-up is also advised.

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Section: Maintenance Therapy and Long-term Outcomesmentioning

confidence: 99%

The role of maintenance therapy in eosinophilic esophagitis: who, why, and how?

Philpott

Dellon

2017

J Gastroenterol

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“…Optimal dose and duration are debated, although maintenance topical corticosteroids may decrease endoscopic relapse rates, strictures and food bolus impaction . Side effects of topical corticosteroids in other settings (eg asthma and seasonal rhinitis) have included adrenal insufficiency, and have been reported in patients receiving topical corticosteroids for EoE . However, risk estimates of adrenal insufficiency due to topical corticosteroids in EoE are lacking, due to recent recognition of the condition and treatment trials with short follow up periods.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Side effects of topical corticosteroids in other settings (eg asthma and seasonal rhinitis) have included adrenal insufficiency, and have been reported in patients receiving topical corticosteroids for EoE. 9,10 However, risk estimates of adrenal insufficiency due to topical corticosteroids in EoE are lacking, due to recent recognition of the condition and treatment trials with short follow up periods. Consequently there are no clinical guidelines for assessment of this iatrogenic phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Systematic review: adrenal insufficiency secondary to swallowed topical corticosteroids in eosinophilic oesophagitis

Philpott

Dougherty

Reed

et al. 2018

Aliment Pharmacol Ther

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“… 25 Adrenal insufficiency has been seen with both oral budesonide and fluticasone propionate. 23 Long-term side effects of PPI include increased rates of infections, vitamin deficiencies (calcium, magnesium, B12, and iron), bone fractures, anemia, dementia, and kidney disease. 26 It is important for the clinician to be aware and monitor for these side effects, especially since patients with EoE will remain on these medicines for months or years.…”

Section: Discussionmentioning

confidence: 99%

Esophageal polyp in a teenage boy with eosinophilic esophagitis

Schor

Blanco

Rivera-Nieves

et al. 2022

SAGE Open Medical Case Reports

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The association of eosinophilic esophagitis and esophageal polyps has been reported in the literature but remains a rare finding in both adults and children. The patient in this case report presented with progressively worsening dysphagia secondary to eosinophilic esophagitis and an esophageal polyp. Dysphagia is always abnormal, and endoscopic evaluation is essential. Dysphagia is a well-known symptom in patients with eosinophilic esophagitis. While esophageal polyps as a whole are less common in the pediatric population, they should not be overlooked as a possible cause of dysphagia and esophageal obstruction.

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Adrenal insufficiency exists for both swallowed budesonide and fluticasone propionate in the treatment of eosinophilic esophagitis

Cited by 6 publications

References 2 publications

The role of maintenance therapy in eosinophilic esophagitis: who, why, and how?

The role of maintenance therapy in eosinophilic esophagitis: who, why, and how?

Systematic review: adrenal insufficiency secondary to swallowed topical corticosteroids in eosinophilic oesophagitis

Esophageal polyp in a teenage boy with eosinophilic esophagitis

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