Rubinstein Eitan, Hait Elizabeth E, Mitchell Paul D, Lee John J
Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School.
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital.
J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):395-397. doi: 10.1097/MPG.0000000000001718.
Eosinophilic esophagitis (EoE) is a clinicopathologic disorder characterized histologically by esophageal eosinophilia. Oral viscous budesonide (OVB) is an effective treatment with remission rates reported between 55% and 87%; however, topical corticosteroids are associated with increased risk of candidal esophagitis and adrenal suppression. Attempts to decrease the daily dose of topical steroids have resulted in disease relapse. The objective of this study was to determine whether or not reducing the frequency of OVB administration would be effective in controlling esophageal eosinophilia in children and adolescents.
Data were obtained by retrospective chart review of patients at Boston Children's Hospital diagnosed with EoE, based on endoscopic findings of >15 eosinophils per high power field (eos/HPF) on esophageal biopsies while on acid blockade. Patients with histologic evidence of response (<15 eos/HPF) while on daily OVB had been offered the option of maintenance therapy based on a Monday-Wednesday-Friday (MWF) dosing regimen. Changes in peak esophageal eosinophil counts over time were examined.
Eight male patients ages 5 to 18 years attained clinical response while receiving daily OVB and were subsequently maintained on a MWF OVB dosing regimen for 3 to 7 months. All 8 patients showed an increase in peak esophageal eosinophils, with 7 of 8 (88%) experiencing disease relapse. In fact, the distribution of peak esophageal eosinophils after MWF dosing was not statistically different from peak levels at diagnosis (P = 0.95).
An MWF dosing regimen of OVB was not effective at maintaining histologic response in children and adolescents with EoE. Larger prospective studies are warranted to confirm these results.
嗜酸性粒细胞性食管炎（EoE）是一种临床病理疾病，组织学特征为食管嗜酸性粒细胞增多。口服粘性布地奈德（OVB）是一种有效的治疗方法，缓解率报告在55%至87%之间；然而，局部使用皮质类固醇会增加念珠菌性食管炎和肾上腺抑制的风险。尝试减少局部类固醇的每日剂量会导致疾病复发。本研究的目的是确定减少OVB给药频率是否能有效控制儿童和青少年的食管嗜酸性粒细胞增多。
通过回顾性图表审查波士顿儿童医院诊断为EoE的患者的数据，这些患者基于在酸阻断治疗时食管活检每高倍视野（eos/HPF）>15个嗜酸性粒细胞的内镜检查结果。在每日使用OVB时有组织学反应证据（<15 eos/HPF）的患者可选择基于周一至周三至周五（MWF）给药方案的维持治疗。检查随时间食管嗜酸性粒细胞峰值计数的变化。
8名年龄在5至18岁的男性患者在接受每日OVB治疗时达到临床反应，随后接受MWF OVB给药方案维持治疗3至7个月。所有8名患者的食管嗜酸性粒细胞峰值均增加，8名患者中有7名（88%）疾病复发。事实上，MWF给药后食管嗜酸性粒细胞峰值的分布与诊断时的峰值水平在统计学上无差异（P = 0.95）。
MWF OVB给药方案对维持EoE儿童和青少年的组织学反应无效。需要更大规模的前瞻性研究来证实这些结果。
