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Adrenal Suppression in Children Treated With Oral Viscous Budesonide for Eosinophilic Esophagitis

Shira Harel1, Brenden E Hursh, Edmond S Chan

  • 1*Endocrinology and Diabetes Unit †Division of Allergy and Immunology, Department of Pediatrics ‡Division of Pediatric Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC.

Journal of Pediatric Gastroenterology and Nutrition
|May 8, 2015
PubMed

Insights

Children treated with oral viscous budesonide (OVB) for eosinophilic esophagitis may face a risk of adrenal suppression (AS). A study found 43% of pediatric patients on OVB had suboptimal cortisol levels, indicating a potential safety concern.

Area of Science:

  • Pediatric Endocrinology
  • Gastroenterology
  • Pharmacology

Background:

  • Eosinophilic esophagitis (EoE) is a chronic inflammatory condition.
  • Oral viscous budesonide (OVB) is a common treatment for EoE in children.
  • Adrenal suppression (AS) is a potential side effect of corticosteroid therapy.

Purpose of the Study:

  • To determine the prevalence of adrenal suppression (AS) in pediatric patients with eosinophilic esophagitis (EoE) treated with oral viscous budesonide (OVB).
  • To assess the endocrine safety of OVB in a pediatric population.

Main Methods:

  • Retrospective review of a quality assurance initiative.
  • Inclusion of pediatric patients treated with OVB for at least 3 months.
  • Endocrine assessment including 1 μg adrenocorticotropic hormone stimulation test for referred patients.

Main Results:

  • 14 out of 19 children completed the endocrine assessment.
  • 6 out of 14 children (43%) exhibited suboptimal stimulated cortisol levels (below 500 nmol/L).
  • No significant association found between AS and treatment duration, OVB dose, or concurrent use of inhaled/nasal corticosteroids.

Conclusions:

  • Pediatric patients with EoE treated with OVB may be at risk for adrenal suppression.
  • Routine endocrine monitoring should be considered for children on long-term OVB therapy.
  • Further research is warranted to fully understand the long-term implications of OVB-induced AS in children.

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