Adrenal Suppression in Children Treated With Oral Viscous Budesonide for Eosinophilic Esophagitis

Abstract

We sought to determine the prevalence of adrenal suppression (AS) in children with eosinophilic esophagitis treated with oral viscous budesonide (OVB). This was a retrospective review of a quality assurance initiative, whereby all children in our center treated with OVB for ≥3 months were referred over an 18-month time frame for endocrine assessment including 1 μg adrenocorticotropic hormone stimulation test. Fourteen of 19 children complied with the referral; of these 14 children, 6 (43%) had suboptimal stimulated cortisol (range 343-497 nmol/L, mean [±SD] 424.7 nmol/L [±52.4], normal ≥500 nmol/L). There was no significant association to treatment duration, dose, or concomitant use of inhaled/nasal corticosteroids. This study suggests that children treated with OVB may be at risk for AS.

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

“…We identified 1610 unique reports, and 17 met inclusion criteria (Tables and ) . There were 7 randomised controlled trials, 6 prospective observational studies, 3 retrospective observational studies, and 1 case report (Figure ).…”

“…Observational studies evaluated longer durations of treatment (up to 3.7 years, Table ). Mean duration of topical corticosteroid use prior to investigation (when stated) was 22 months (range 10‐43 months) . Adrenal insufficiency was the primary endpoint in 6 of 10 studies .…”

“…Adrenal insufficiency was defined heterogeneously. Five studies used LDST, measuring peak cortisol at different intervals from 15 to 60 minutes post‐stimulation. Thresholds for adrenal insufficiency by unstimulated serum cortisol varied from 55 to 276 nmol/L [2 to 10 mcg/dL] .…”

Management of proton pump inhibitor responsive-esophageal eosinophilia and eosinophilic esophagitis: controversies in treatment approaches

“…Furthermore, endoscopy did not reveal signs of esophageal atrophy [111,112]. A recently published small pilot study of pediatric patients with EoE receiving oral viscous budesonide for more than three months revealed that there may be a risk of adrenal insufficiency [116]. However, larger studies of adults and children did not observe an effect on the adrenal axis [44,62,63,67,68,117].…”

Eosinophilic Esophagitis From an Allergy Perspective: How to Optimally Pursue Allergy Testing & Dietary Modification in the Adult Population

“…In comparison to the other available treatment options, dietary therapy has the potential to eliminate the underlying cause of inflammation, which has been shown to lead to long-term remission in patients when trigger foods are identified [17•]. Furthermore, it is not associated with the potential side effect profile of chronic steroid use, such as adrenal suppression [18], the development of cataracts [19], and esophageal candidiasis [20, 21]. As there are also limitations to this therapy, which will be discussed, the ultimate decision should be tailored to the patient’s background and preferences, provider experience, and the availability of local resources.…”