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

Abstract

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