Bhardwaj Neeti, Ishmael Faoud, Lehman Erik, Bethards Deborah, Ruggiero Francesca, Ghaffari Gisoo
Allergy Rhinol (Providence). 2017 Jun 1;8(2):85-94. doi: 10.2500/ar.2017.8.0202.
Topical corticosteroids have proven efficacy in the treatment of eosinophilic esophagitis (EoE) and are considered the cornerstone of therapy.
To evaluate the effect of topical beclomethasone dipropionate (BDP) therapy on clinical outcomes, esophageal eosinophilia, and other markers of inflammation in patients with EoE.
Nine subjects with a biopsy-proven diagnosis of EoE were enrolled. In a cross-over design, the subjects were randomly assigned to a sequence of BDP and placebo. Treatment periods were 8 weeks, with a 4-week washout period. The subjects had endoscopic biopsies and blood tests at baseline and after each treatment period. They were instructed to maintain a diary of symptoms. Immuno-histochemical studies were performed for interleukins IL-4, IL-5, IL-13, granulocyte-macrophage colony-stimulating factor (GM-CSF), and transforming growth factor (TGF) beta. Reverse transcription polymerase chain reaction was performed for IL-3, IL-4, IL-5, IL-10, IL-13, IL-17F, IL-25, IL-33, chemokine ligands (CCL)2, CCL5, CCL11, GM-CSF, and TGF-beta levels. The mast cell tryptase (MCT) level was measured in esophageal tissues.
BDP led to a significantly larger decrease in esophageal eosinophilia compared with placebo, but there was no significant change in peripheral eosinophilia and high-sensitivity C-reactive protein between the two groups. The study was not powered enough for us to report a significant improvement in clinical symptoms. There was a significant decrease in tissue IL-13 and MCT levels from baseline to the end of treatment between the treatment and placebo groups. Mean fold decreases in cytokine expression between the baseline and treatment groups were observed for IL-17F, IL-25, CCL2, and CCL5.
Treatment with topical BDP was associated with significant decrease in esophageal eosinophilia, MCT and IL-13. BDP is a potential alternative to fluticasone propionate and budesonide for treatment of EoE. Larger studies are needed to validate these findings.
外用糖皮质激素已被证明对嗜酸性食管炎（EoE）的治疗有效，被视为治疗的基石。
评估外用二丙酸倍氯米松（BDP）治疗对EoE患者临床结局、食管嗜酸性粒细胞增多及其他炎症标志物的影响。
招募9例经活检证实诊断为EoE的受试者。采用交叉设计，将受试者随机分配至BDP和安慰剂序列。治疗期为8周，洗脱期为4周。受试者在基线及各治疗期结束时进行内镜活检和血液检查。指导他们记录症状日记。对白细胞介素IL-4、IL-5、IL-13、粒细胞-巨噬细胞集落刺激因子（GM-CSF）和转化生长因子（TGF）β进行免疫组织化学研究。对IL-3、IL-4、IL-5、IL-10、IL-13、IL-17F、IL-25、IL-33、趋化因子配体（CCL）2、CCL5、CCL11、GM-CSF和TGF-β水平进行逆转录聚合酶链反应。测量食管组织中的肥大细胞类胰蛋白酶（MCT）水平。
与安慰剂相比，BDP使食管嗜酸性粒细胞显著减少，但两组外周嗜酸性粒细胞和高敏C反应蛋白无显著变化。该研究的样本量不足以让我们报告临床症状有显著改善。治疗组和安慰剂组从基线到治疗结束时组织IL-13和MCT水平均显著降低。观察到基线和治疗组之间细胞因子表达的平均倍数下降情况，涉及IL-17F、IL-25、CCL2和CCL5。
外用BDP治疗与食管嗜酸性粒细胞、MCT和IL-13显著减少相关。BDP是丙酸氟替卡松和布地奈德治疗EoE的潜在替代药物。需要更大规模的研究来验证这些发现。
