A brief report adds useful information for topical therapy for eosinophilic esophagitis (EoE) (Gastroenterol 2012; 143: 321-24).  This study involved 25 subjects in a prospective randomized open label design that compared budesonide delivered via either as a metered nebulized form (NEB) or as oral viscous solution (1 mg BID).  The mean age of the subjects was 35 years, 60% were male, 88% were caucasian, and all had dysphagia.

Findings:

• Orally administered viscous budesonide (OVB) was more effective at lowering esophageal eosinophilia.  After treatment, eosinophil count per high power field was 11 for OVB compared with 89 for NEB formulation.
• Nuclear scintigraphy showed that OVB had a significantly higher level of esophageal exposure to the therapeutic agent than NEB and did not result in lung exposure (which occurred in NEB group)
• Both groups had improvement in dysphagia.  Poor correlation of symptoms and histology has frequently been reported.

These findings along with the fact that budesonide has less systemic corticosteroid effects, due to a high first-pass metabolism, makes OVB a logical choice for patients treated with topical steroids.

Previous related blog entries:

Guidelines for Eosinophilic Esophagitis

Looking better or feeling better in EoE?

Look of improvement on an EoE diet

Eosinophilic Esophagitis -Six Food Group Diet

MicroRNA signature for eosinophilic esophagitis

The undiscovered country