Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis

Abstract

We performed a randomized trial to compare nebulized and viscous topical corticosteroid treatments for eosinophilic esophagitis (EoE). Subjects with incident EoE (n = 25) received budesonide 1 mg twice daily, either nebulized and then swallowed (NEB) or as an oral viscous slurry (OVB), for 8 weeks. Baseline eosinophil counts for the NEB and OVB groups were 101 and 83 (P = .62). Posttreatment counts were 89 and 11 (P = .02). The mucosal medication contact time, measured by scintigraphy, was higher for the OVB group than the NEB group (P < .005) and was inversely correlated with eosinophil count (R = -0.67; P = .001). OVB was more effective than NEB in reducing numbers of esophageal eosinophils in patients with EoE. OVB provided a significantly higher level of esophageal exposure to the therapeutic agent, which correlated with lower eosinophil counts.

Trial registration: ClinicalTrials.gov NCT00961233.

Conflict of interest statement

Disclosures: There are no potential conflicts of interest for any of the authors pertaining to this study. The funding organizations had no role in the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and drafting of the manuscript. Study is registered at clinicaltrials.gov (NCT00961233).

Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Illustrative examples of nuclear scintigraphy esophageal emptying scans for the OVB (panel A) and NEB (panel B) groups. These images represent the total distribution of 99mTc-DTPA tracer throughout the imaging period. Note that for OVB, the medication deposit only in the oropharynx, esophagus and stomach, while for NEB there is also medication deposition in the lungs. In addition, there is qualitatively more deposition in the esophagus and stomach of OVB compared with NEB.

Figure 1

Illustrative examples of nuclear scintigraphy esophageal emptying scans for the OVB (panel A) and NEB (panel B) groups. These images represent the total distribution of 99mTc-DTPA tracer throughout the imaging period. Note that for OVB, the medication deposit only in the oropharynx, esophagus and stomach, while for NEB there is also medication deposition in the lungs. In addition, there is qualitatively more deposition in the esophagus and stomach of OVB compared with NEB.