P0498 - The Role of Steroids in Eosinophilic Esophagitis: A Meta-Analysis

Bipneet Singh, MD¹, Thai Hau Koo, MD², Nidhishri Sridhar, MD³, Sruthi Ramanan, MD^1
1Henry Ford Jackson Hospital, Jackson, MI; ²Hospital University of Science, Kubang Kerian, Kelantan, Malaysia; ³Heart and Vascular Institution, Bangalore, Karnataka, India

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus characterized by eosinophilic infiltration. Swallowed topical steroids have been the preferred medications for EoE as they relieve symptoms and restore the pathology to normal levels. This meta-analysis aims to evaluate the effectiveness of topical steroids in improving histologic, clinical, and endoscopic outcomes compared to placebo in patients with EoE.

Methods: A comprehensive literature search was performed from major databases (PubMed, EMBASE, Medline, ISI Web of Science, and Cochrane Database of Systematic Reviews) from inception to May 2023 to identify relevant randomized controlled trials (RCTs) that compared topical steroid therapy with placebo to treat EoE. The primary outcomes assessed were histological response, clinical response rate, and endoscopic response rates in EoE patients treated with topical steroids compared to placebo. Pooled estimates were calculated using a random-effects model with 95% confidence intervals (CI) using odds ratios (OR) for dichotomous diseases. The statistical analysis was performed using Review Manager (RevMan) software.

Results: Nine randomized controlled trials (RCTs) were included, with 193 participants in total, 102 receiving topical steroids, and 91 being included in the placebo group. Topical corticosteroids were significantly more effective than placebo in inducing histologic response (OR 37.81, 95% CI: 14.98 to 85.64, p < 0.00001). They were also more effective in inducing clinical response (OR 2.53, 95% CI: 1.14 to 5.60, p = 0.02). The endoscopic response rate was higher in the steroid group (OR 3.51, 95% CI: 1.51 to 8.14, p = 0.004). The heterogeneity among studies for histologic, clinical, and endoscopic outcomes was low to moderate (I2 = 0% to 60%).

Discussion: Topical steroids demonstrate significant efficacy in improving histologic, clinical, and endoscopic outcomes in patients with EoE. The observed low to moderate heterogeneity among studies suggests a consistent benefit of steroid therapy despite the fact that infections, the most frequently reported side effects, were mild and almost always tolerated without severe consequences. Further research is necessary to confirm long-term safety and efficacy and to refine treatment regimens.


Disclosures:


Bipneet Singh, MD¹, Thai Hau Koo, MD², Nidhishri Sridhar, MD³, Sruthi Ramanan, MD¹. P0498 - The Role of Steroids in Eosinophilic Esophagitis: A Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.