PDF(Pubmed)
Abstract：
OBJECTIVE: To develop evidence-based guidance for topical steroid use in paediatric eosinophilic oesophagitis (pEoE) in the UK for both induction and maintenance treatment.
METHODS: A systematic literature review using Cochrane guidance was carried out by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Eosinophilic Oesophagitis (EoE) Working Group (WG) and research leads to determine the evidence base for preparation, dosing and duration of use of swallowed topical steroid (STS) formulations in EoE. Seven themes relating to pEoE were reviewed by the WG, alongside the Cochrane review this formed the evidence base for consensus recommendations for pEoE in the UK. We provide an overview of practical considerations including treatment regimen and dosing. Oral viscous budesonide (OVB) and, if agreed by local regulatory committees, orodispersible budesonide (budesonide 1 mg tablets) were selected for ease of use and with most improvement in histology. A practical \'how to prepare and use\' OVB appendix is included. Side effects identified included candidiasis and adrenal gland suppression. The use of oral systemic steroids in strictures is discussed briefly.
RESULTS: 2638 citations were identified and 18 randomised controlled trials were included. Evidence exists for the use of STS for induction and maintenance therapy in EoE, especially regarding histological improvement. Using the Appraisal of Guidelines, Research and Evaluation criteria, dosing of steroids by age (0.5 mg two times per day <10 years and 1 mg two times per day ≥10 years) for induction of at least 3 months was suggested based on evidence and practical consideration. Once histological remission is achieved, maintenance dosing of steroids appears to reduce the frequency and severity of relapse, as such a maintenance weaning regimen is proposed.
CONCLUSIONS: A practical, evidence-based flow chart and guidance recommendations with consensus from the EoE WG and education and research representatives of BSPGHAN were developed with detailed practical considerations for use in the UK.
METHODS: A systematic literature review using Cochrane guidance was carried out by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Eosinophilic Oesophagitis (EoE) Working Group (WG) and research leads to determine the evidence base for preparation, dosing and duration of use of swallowed topical steroid (STS) formulations in EoE. Seven themes relating to pEoE were reviewed by the WG, alongside the Cochrane review this formed the evidence base for consensus recommendations for pEoE in the UK. We provide an overview of practical considerations including treatment regimen and dosing. Oral viscous budesonide (OVB) and, if agreed by local regulatory committees, orodispersible budesonide (budesonide 1 mg tablets) were selected for ease of use and with most improvement in histology. A practical \'how to prepare and use\' OVB appendix is included. Side effects identified included candidiasis and adrenal gland suppression. The use of oral systemic steroids in strictures is discussed briefly.
RESULTS: 2638 citations were identified and 18 randomised controlled trials were included. Evidence exists for the use of STS for induction and maintenance therapy in EoE, especially regarding histological improvement. Using the Appraisal of Guidelines, Research and Evaluation criteria, dosing of steroids by age (0.5 mg two times per day <10 years and 1 mg two times per day ≥10 years) for induction of at least 3 months was suggested based on evidence and practical consideration. Once histological remission is achieved, maintenance dosing of steroids appears to reduce the frequency and severity of relapse, as such a maintenance weaning regimen is proposed.
CONCLUSIONS: A practical, evidence-based flow chart and guidance recommendations with consensus from the EoE WG and education and research representatives of BSPGHAN were developed with detailed practical considerations for use in the UK.
摘要：
目的：为英国儿童嗜酸性粒细胞性食管炎（pEoE）的局部使用类固醇进行诱导和维持治疗制定循证指导。
方法：英国儿科胃肠病学会使用Cochrane指导进行了系统的文献综述，肝病和营养（BSPGHAN）嗜酸细胞性食管炎（EoE）工作组（WG）和研究导致确定准备的证据基础，EoE中吞咽局部类固醇（STS）制剂的剂量和使用持续时间。工作组审查了与项目有关的七个主题，与Cochrane审查一起,这构成了英国pEoE共识建议的证据基础.我们提供了实际考虑因素的概述，包括治疗方案和剂量。口腔粘稠布地奈德（OVB）和，如果当地监管委员会同意，选择口腔分散布地奈德（布地奈德1mg片剂），便于使用，组织学改善最大。包括实用的“如何准备和使用”OVB附录。确定的副作用包括念珠菌病和肾上腺抑制。简要讨论了在狭窄中口服全身性类固醇的使用。
结果：共确定了2638篇引文，纳入了18项随机对照试验。有证据表明在EoE中使用STS进行诱导和维持治疗，特别是关于组织学改善。使用准则评估，研究和评估标准，根据证据和实际考虑，建议按年龄给药类固醇（0.5mg每天两次<10岁，1mg每天两次≥10岁），诱导至少3个月。一旦达到组织学缓解，类固醇的维持剂量似乎减少复发的频率和严重程度，因此，提出了一种维持断奶方案。
结论：实用，在EoEWG和BSPGHAN的教育和研究代表的共识下,制定了基于证据的流程图和指导建议,并详细考虑了在英国使用的实际考虑.
方法：英国儿科胃肠病学会使用Cochrane指导进行了系统的文献综述，肝病和营养（BSPGHAN）嗜酸细胞性食管炎（EoE）工作组（WG）和研究导致确定准备的证据基础，EoE中吞咽局部类固醇（STS）制剂的剂量和使用持续时间。工作组审查了与项目有关的七个主题，与Cochrane审查一起,这构成了英国pEoE共识建议的证据基础.我们提供了实际考虑因素的概述，包括治疗方案和剂量。口腔粘稠布地奈德（OVB）和，如果当地监管委员会同意，选择口腔分散布地奈德（布地奈德1mg片剂），便于使用，组织学改善最大。包括实用的“如何准备和使用”OVB附录。确定的副作用包括念珠菌病和肾上腺抑制。简要讨论了在狭窄中口服全身性类固醇的使用。
结果：共确定了2638篇引文，纳入了18项随机对照试验。有证据表明在EoE中使用STS进行诱导和维持治疗，特别是关于组织学改善。使用准则评估，研究和评估标准，根据证据和实际考虑，建议按年龄给药类固醇（0.5mg每天两次<10岁，1mg每天两次≥10岁），诱导至少3个月。一旦达到组织学缓解，类固醇的维持剂量似乎减少复发的频率和严重程度，因此，提出了一种维持断奶方案。
结论：实用，在EoEWG和BSPGHAN的教育和研究代表的共识下,制定了基于证据的流程图和指导建议,并详细考虑了在英国使用的实际考虑.
