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World J Gastroenterol. Sep 28, 2020; 26(36): 5395-5407
Published online Sep 28, 2020. doi: 10.3748/wjg.v26.i36.5395
Treatment of eosinophlic esophagitis with swallowed topical corticosteroids
Simon Nennstiel, Christoph Schlag
Simon Nennstiel, Christoph Schlag, Klinikum rechts der Isar der Technischen Universität München, Klinik und Poliklinik für Innere Medizin II, Munich 81675, Germany
Author contributions: All authors contributed to this work.
Conflict-of-interest statement: Nennstiel S received compensation for travel expenses by the Falk Foundation e.V. and Adare Pharmaceuticals, Inc.; Schlag C is a member of the advisory board of Adare Pharmaceuticals, EsoCap and Calypso and received speaker fees, travel and research funding from Dr. Falk Pharma GmbH and Falk Foundation e.V.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Christoph Schlag, MD, Klinikum rechts der Isar der Technischen Universität München, Klinik und Poliklinik für Innere Medizin II, Ismaninger Straße 22, Munich 81675, Germany. christoph.schlag@mri.tum.de
Received: March 18, 2020
Peer-review started: March 18, 2020
First decision: May 15, 2020
Revised: June 9, 2020
Accepted: September 17, 2020
Article in press: September 17, 2020
Published online: September 28, 2020
Processing time: 189 Days and 11.6 Hours
Abstract

Eosinophilic esophagitis (EoE) is an emerging chronic local immune-mediated disease of the esophagus. Beside proton pump inhibitors and food-restriction-diets swallowed topical corticosteroids (STC) can be offered as a first line therapy according to current guidelines. This review describes the background and practical management of STCs in EoE. So far, mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications “off label”. Recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85% - an orodispersible tablet of budesonide has been approved as the first “in label” medication for EoE in Europe in June 2018. Whereas it was shown that disease remission induction of EoE by STCs is highly effective, there is still a lack of data regarding long-term and maintenance therapy. However, current studies on STC maintenance therapy add some movement into the game.

Keywords: Eosinophilic esophagitis; Swallowed topical corticosteroids; Esophagus-targeted formulations of topical steroids; Fluticasone; Budesonide; Budesonide orodispersible tablet; Budesonide oral suspension

Core Tip: Swallowed topical corticosteroids are a very effective and safe treatment option in eosinophilic esophagitis. Particularly, esophagus-targeted formulations can induce clinicopathological remission in the vast majority of patients. However, uncertainness regarding optimal dosage and duration of long-term treatment still exists.