Eosinophilic Oesophagitis in Children: Disease Modulation by Topical Steroids

Abstract

Purpose of review

Eosinophilic oesophagitis (EoE) is a chronic inflammatory disease, and effective treatment for paediatric EoE is still evolving. There is no consensual standard therapy for adults or children, as evolving concepts still need to be properly validated and there has been continuous update from published trials. This paper summarizes the current knowledge about inflammatory background and corticosteroid therapy in paediatric eosinophilic oesophagitis.

Recent findings

There are some effective therapies in EoE treatment, and currently, the use of PPI may be considered as the first-line treatment, as a sub-group of EoE patients can be responsive to them. However, a considerable proportion of patients will not respond both clinically and histologically or will recur. Various dietary options and topical steroids are valid alternatives.

Basic research has shown that corticosteroids downregulate inflammation and prevent remodelling, reducing the long-term complication rate, mainly related to stenosis.

Corticosteroids are effective and safe especially if delivered in a viscous solution (budesonide, fluticasone). New formulations may be available soon thereby sparing the need for home-made manipulations. Clinical remission and the possibility to maintain treatment for long periods without serious side-effects make this option attractive in paediatric patients that have the prospect of long-term disease.

Summary

Corticosteroids are effective as induction and maintenance therapy and can be used safely in long-term therapy in childhood, leading to sustained remission.

Active research will provide further evidence to consolidate outcome and length of treatment.

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