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Non-surgical interventions for eosinophilic oesophagitisKukuruzovic RH, Elliott EJ, O'Loughlin E(V, Markowitz JE
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SummaryA systematic review of the literature did not identify any randomised controlled trials evaluating the benefits and harms of medical treatments for eosinophilic oesophagitis.People with eosinophilic oesophagitis (EO) present with difficulty swallowing, vomiting, regurgitation, and chest and/or abdominal pain. Frequently, symptoms do not resolve with acid suppressive treatment or anti-reflux surgery. The cause of EO is unknown; however dietary and/or environmental factors may contribute to disease. In our systematic review we found no completed randomised controlled trials (RCTs) evaluating treatments for eosinophilic oesophagitis. Two RCTs are currently underway. One compares steroid spray with oral prednisolone and the other compares steroid spray with placebo.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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July 19. 2004 AbstractBackgroundPatients with eosinophilic oesophagitis (EO) present with difficulty swallowing, vomiting, regurgitation, chest and/or abdominal pain. People with EO frequently fail to respond to treatment with gastric acid suppressants or anti-reflux surgery. ObjectivesTo evaluate the benefits and harms of medical interventions for eosinophilic oesophagitis. Search strategyWe searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group trials register (The Cochrane Library Issue 1, 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February 2004) and EMBASE (1980 to February 2004). These searches were run again in February 2005 and 2006 but no new trials were found. Selection criteriaRandomised controlled trials were included if they compared a medical or dietary intervention for eosinophilic oesophagitis with a placebo or one medical intervention with another medical intervention. Data collection and analysisTwo reviewers independently screened the title of abstracts. Main resultsNo completed RCTs were found in the published literature. We found one abstract reporting preliminary data from an RCT (not completed) comparing oral prednisolone with topical (swallowed metered dose) fluticasone in children. In this study (50 children enrolled to date) healing rates of oesophagitis and symptom resolution with fluticasone were similar to those with prednisolone. For another ongoing RCT, comparing the efficacy of swallowed fluticasone with placebo for eosinophilic oesophagitis in males and females aged 3 to 21 years no results are available. Authors' conclusionsThe lack of completed RCT's makes it impossible to compare the relative benefits and harms of the wide range of medical interventions currently used for treating EO. Published case series suggest that an elemental diet, oral steroids and topical steroids all offer some benefits. However, lack of a comparison group in these studies makes it impossible to evaluate the effect of these interventions. |