Update on topical steroid therapy for eosinophilic esophagitis

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disease.
• Topical steroids (TS) are currently used off-label for EoE management.
• Existing TS formulations were not specifically designed for esophageal delivery.

Purpose of the Study:

• To review current evidence on topical steroid (TS) therapy for eosinophilic esophagitis (EoE).
• To discuss evolving treatment strategies and novel formulations for EoE.
• To highlight challenges such as steroid resistance and long-term safety.

Main Methods:

• Literature review of studies on topical steroid therapy in EoE.
• Analysis of different administration routes and dosages of TS.
• Evaluation of novel steroid formulations and management strategies.

Main Results:

• Oral viscous budesonide shows better histological outcomes than swallowed aerosolized steroids.
• High-dose fluticasone demonstrates increased cure rates in pediatric and adult EoE patients.
• Novel EoE-specific steroid formulations report high preliminary cure rates (~100%).
• Steroid resistance affects 25-40% of patients; narrow esophagus may cause persistent dysphagia.

Conclusions:

• Topical steroids are effective for EoE, with improved outcomes from direct oral administration and high-dose regimens.
• Novel, EoE-targeted steroid formulations show promising efficacy.
• Long-term safety data for TS in EoE is lacking.
• Maintenance therapy is recommended to prevent recurrence and remodeling, though optimal strategies are undefined.