Abstract：
Topical steroids are commonly used in treatment of eosinophilic esophagitis (EoE), but currently there is lack of data to clarify most effective regimen. We aimed to study the achievement of histologic remission using the same dose of budesonide in two different delivery formulations. Patients with established EoE treated with pharmacy compounded budesonide capsule or budesonide Rincinol gel (both 3 mg twice daily) were studied retrospectively. Those with pre-treatment and post-treatment histologic assessment were included with main endpoint being histologic remission. 103 patients (62 gel, 41 capsule) were included, with higher rate of histologic remission with gel (84 vs. 59%, P=0.004). A subset of patients in both groups had lack of steroid response (<50% drop in eosinophils) (15% for gel, 32% for capsule). Formulation/delivery vehicle of steroid treatments to esophageal mucosa in EoE appears important for treatment efficacy, with budesonide gel having higher likelihood of histologic remission compared to budesonide capsules in our population. A truly steroid refractory group appears likely in our population. Larger, prospective studies may help clarify best regimen of topical steroids in EoE and may work to identify patients likely to benefit from alternative therapies.
摘要：
局部类固醇通常用于治疗嗜酸性粒细胞性食管炎（EoE），但目前缺乏数据来阐明最有效的治疗方案.我们旨在研究在两种不同的递送制剂中使用相同剂量的布地奈德实现组织学缓解。回顾性研究了使用药学复合布地奈德胶囊或布地奈德林卡诺凝胶（均为3mg，每天两次）治疗的EoE确定的患者。包括治疗前和治疗后组织学评估的患者，主要终点是组织学缓解。103名患者（62名凝胶，41粒胶囊)包括在内，凝胶的组织学缓解率较高(84vs.59%,P=0.004)。两组中的一部分患者缺乏类固醇反应（嗜酸性粒细胞下降<50％）（凝胶为15％，32%为胶囊)。在EoE中，对食管粘膜进行类固醇治疗的制剂/递送载体对治疗效果很重要。在我们的人群中，与布地奈德胶囊相比，布地奈德凝胶具有更高的组织学缓解可能性。在我们的人群中可能出现真正的类固醇难治性组。较大,前瞻性研究可能有助于阐明EoE局部用类固醇的最佳治疗方案,并可能有助于确定可能从替代疗法中获益的患者.
