Meta-analysis of the role of steroids in Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus that manifests as eosinophil-predominant infiltration. Swallowed topical steroids have been the preferred medications for EoE as they relieve symptoms and restore the pathology. This meta-analysis comprehensively examined whether steroid application is the best therapy for histologic, cell morphologic, and endoscopic findings compared to placebo in eosinophilic esophagitis.

A literature search was conducted on various medical databases to identify relevant randomized controlled trials (RCTs) that compared topical steroid therapy with placebo to treat EoE. The principal endpoints of the study were histological response, clinical response rate, and endoscopic response rates.

Meta-analysis was carried out with the help of the RevMan software, which utilized odds ratios with 95% confidence intervals for dichotomous diseases.

In the meta-analysis, nine trials with 193 participants combined were considered. Topical corticosteroids were significantly more effective than placebo in inducing the histologic response (Odds Ratio(OR) 37.81, 95% Confidence interval(CI) 14.98-85.64, p<0.00001). They were also more effective than the placebo in inducing a clinical response (OR 2.5).

The most frequently reported side effects were infections, which were mild and almost always tolerated without severe consequences. According to data derived from this meta-analysis, we conclude that topical steroids can be used reliably to reduce the inflammatory response in the esophagus and facilitate clinical and endoscopic improvement by inducing the remission of this condition.