Department of Gastroenterology, Lyell McEwin and Modbury Hospitals, Northern Adelaide Local Health Network (NALHN), University of Adelaide, Adelaide, South Australia, Australia.
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Aliment Pharmacol Ther. 2018 Apr;47(8):1071-1078. doi: 10.1111/apt.14573. Epub 2018 Mar 5.
Swallowed topical corticosteroids are prescribed for eosinophilic oesophagitis (EoE), but there is a theoretical risk of adrenal insufficiency from their use.
To determine if the use of topical corticosteroids to treat EoE is associated with the development of adrenal insufficiency.
We conducted a systematic review of the published literature from January 1, 1950 to April 1, 2017 using Pubmed, Embase, Web of Science and Cochrane Central. Studies and meeting abstracts were included that described patients with EoE who received swallowed topical corticosteroids and any investigation for adrenal insufficiency.
The search revealed 1610 unique publications, and 17 met inclusion criteria. There were 7 randomised controlled trials (RCTs), 6 prospective observational studies, 3 retrospective observational studies, and 1 case report. Cortisol measurements were performed on 596 individuals with EoE who received topical corticosteroids. Adrenal testing was abnormal, as defined by each study, in 94/596 patients (crude rate of 15.8%). Only 2 studies were considered to have a low risk of bias, being randomised controlled trials that estimated adrenal insufficiency in the active treatment and placebo groups, before and after treatment. None of the seven randomised controlled trials demonstrated statistically significantly different rates of adrenal insufficiency between topical corticosteroid and placebo over treatment intervals of 2-12 weeks.
Topical corticosteroids were associated with adrenal insufficiency in a minority of patients. Most cases came from uncontrolled observational studies, with widely varying definitions of adrenal insufficiency. Longer follow-up and larger controlled studies are needed to quantify the risk of adrenal insufficiency with maintenance topical corticosteroid therapy in EoE.
口服皮质类固醇被用于治疗嗜酸性食管炎（EoE），但从理论上讲，它们的使用会导致肾上腺功能不全。
确定口服皮质类固醇治疗 EoE 是否与肾上腺功能不全的发生有关。
我们使用 Pubmed、Embase、Web of Science 和 Cochrane Central 进行了系统的文献回顾，检索时间为 1950 年 1 月 1 日至 2017 年 4 月 1 日。纳入了描述接受口服皮质类固醇治疗的 EoE 患者以及任何肾上腺功能不全检查的研究和会议摘要。
搜索结果显示有 1610 个独特的出版物，其中 17 个符合纳入标准。其中有 7 项随机对照试验（RCT）、6 项前瞻性观察研究、3 项回顾性观察研究和 1 项病例报告。皮质醇测量是在 596 名接受皮质类固醇治疗的 EoE 患者中进行的。根据每个研究的定义，有 94/596 名患者（粗发生率为 15.8%）的肾上腺检查异常。只有 2 项研究被认为具有较低的偏倚风险，它们是随机对照试验，在治疗前和治疗后分别估计了活性治疗组和安慰剂组的肾上腺功能不全。在 2-12 周的治疗期间，7 项 RCT 均未显示皮质类固醇与安慰剂之间肾上腺功能不全的发生率存在统计学差异。
皮质类固醇在少数患者中与肾上腺功能不全有关。大多数病例来自于无对照的观察性研究，其对肾上腺功能不全的定义差异很大。需要进行更长时间的随访和更大规模的对照研究，以量化 EoE 维持性皮质类固醇治疗中肾上腺功能不全的风险。
