Letter: screening for adrenal suppression in paediatric inflammatory bowel disease

Wood, P; Henderson, Paul

doi:10.1111/apt.14861

Cited by 2 publications

(4 citation statements)

References 7 publications

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“…37 The conflicting results in the literature are in part due to the infrequent utilization of the gold standard ACTH stimulation test 38 and many have advocated for more consistent testing and monitoring. 39 Our study has many limitations; most evident are referral and selection bias. We have a sizeable number of patients with EoO being managed at our institution, and by comparison only a small proportion of them also underwent DEXA scans.…”

Section: Discussionmentioning

confidence: 90%

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Stable interval bone density in patients with eosinophilic oesophagitis on topical steroids

et al. 2020

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Objective: This study was undertaken to evaluate the effects of maintenance topical steroids (TSs) used for treatment in adult patients with eosinophilic oesophagitis (EoO) on bone health. Patients and Methods: We performed a retrospective review of patients with EoO (≥15 eosinophils/HPF on oesophageal biopsy) who were seen in the Esophageal Clinic between 1 January 2013 and 31 May 2020, treated with maintenance TS for ≥1 year and underwent bone health evaluation. Dual energy X-ray absorptiometry (DEXA) scans were obtained during steroid induction therapy, with follow-up studies obtained at least 1 year later. Demographic, laboratory, radiographic, endoscopic and histologic findings were reviewed. Results: Twenty-one patients had baseline and follow-up DEXA scans (mean age of 44 years, slight male predominance (61.9%)). TS regimens included Budesonide-Rincinol gel and Budesonide capsules mixed into slurry (induction dose range from 1.5 to 6 mg total daily, maintenance dose range from 0.5 to 6 mg total daily). Mean follow-up between initial and final DEXA was 707 ± 391 days. Mean (±SD) baseline T-score, Z-score and BMD (from spine, hips and femurs) (g/cm 2) were −0.3 ± 1.09, −0.06 ± 0.93 and 1.05 ± 0.15 respectively. Mean (±SD) change in bone mineral density was +0.38% ± 1.5% with mean change in absolute BMD of −0.01 ± 0.04 g/cm 2 (P = 0.3). One patient progressed from normal BMD to osteopenia and none from osteopenia to osteoporosis. Conclusion: Chronic maintenance steroid therapy in this pilot study does not appear to induce significant change in BMD in patients with EoO. Larger and longer trials are needed to validate these conclusions. 1 | INTRODUC TI ON Eosinophilic oesophagitis (EoO) is a common cause of dysphagia in young adults and the incidence and prevalence of EoO have increased dramatically over the past three decades. 1-4 Proton pump inhibitors (PPI), dietary therapy and topical steroids (TSs) are the mainstays of treatment in EoO. PPIs are ineffective in inducing remission in EoO in over 50% of patients. 5 Dietary therapy is effective

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Section: Discussionmentioning

confidence: 90%

“…Only a minority of patients on TS for EoO had associated adrenal insufficiency in a recent meta‐analysis 37 . The conflicting results in the literature are in part due to the infrequent utilization of the gold standard ACTH stimulation test 38 and many have advocated for more consistent testing and monitoring 39 …”

Section: Discussionmentioning

confidence: 99%

Stable interval bone density in patients with eosinophilic oesophagitis on topical steroids

et al. 2020

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“…reporting that proton pump inhibitors (PPIs) might increase the risk of hepatocellular carcinoma (HCC) with an adjusted odds ratio (OR) of 2.86 (95% CI, 2.69-3.04). A doseresponse effect was also reported in this study 1. In view of the widespread use of PPIs for acid-related disorders and inconsistent results reported in previous studies, we conducted a meta-analysis to further investigate the association between long-term PPI use and the risk of HCC.Two investigators independently reviewed published studies in PUBMED and EMBASE from inception to July 2018 using a search strategy that included the terms for "PPIs" and "HCC."…”

mentioning

confidence: 78%

“…We read with great interest the recent observational study by Shao-met all inclusion criteria. [1][2][3][4][5] The pooled OR from these five studies was 1.58 (95% CI 0.91-2.76; P = 0.105; I 2 = 97.7%; P herterogeneity < 0.001) ( Figure 1A). We then performed a sensitivity analysis after excluding two studies that included patients with chronic hepatitis B or C infection.…”

Section: Editorsmentioning

confidence: 99%