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Intervention Review

Non-surgical interventions for eosinophilic oesophagitis

  1. Renata H Kukuruzovic1,*,
  2. Elizabeth J Elliott2,
  3. Edward (Ted) V O'Loughlin3,
  4. Jonathan E Markowitz4

Editorial Group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 1 FEB 2006

DOI: 10.1002/14651858.CD004065.pub2

Database Title

Additional Information

How to Cite

Kukuruzovic RH, Elliott EJ, O'Loughlin ETEDV, Markowitz JE. Non-surgical interventions for eosinophilic oesophagitis. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004065. DOI: 10.1002/14651858.CD004065.pub2.

Author Information

  1. 1

    Unversity of Melbourne, Senior Lecturer, Department of Paediatrics, Melbourne, Victoria, Australia

  2. 2

    The Children's Hospital at Westmead; The University of Sydney, Department of Paediatrics and Child Health, Director of Centre for Evidence Based Paediatric Gastro, Westmead, NSW, Australia

  3. 3

    The Children's Hospital at Westmead, Department of Gastroenterology, Sydney, NSW, Australia

  4. 4

    The Children's Hospital of Philadelphia, Division of GI and Nutrition, Philadelphia, USA

*Renata H Kukuruzovic, Senior Lecturer, Department of Paediatrics, Unversity of Melbourne, 4th Floor, Front Building, Royal Children's Hospital, Parkville, Melbourne, Victoria, 3052, Australia. renata.kukuruzovic@rch.org.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Patients with eosinophilic oesophagitis (EO) present with difficulty swallowing, vomiting, regurgitation, chest and/or abdominal pain. People with EO frequently fail to respond to treatment with gastric acid suppressants or anti-reflux surgery.

Objectives

To evaluate the benefits and harms of medical interventions for eosinophilic oesophagitis.

Search strategy

We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group trials register (The Cochrane Library Issue 1, 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February 2004) and EMBASE (1980 to February 2004). These searches were run again in February 2005 and 2006 but no new trials were found.

Selection criteria

Randomised controlled trials were included if they compared a medical or dietary intervention for eosinophilic oesophagitis with a placebo or one medical intervention with another medical intervention.

Data collection and analysis

Two reviewers independently screened the title of abstracts.

Main results

No completed RCTs were found in the published literature. We found one abstract reporting preliminary data from an RCT (not completed) comparing oral prednisolone with topical (swallowed metered dose) fluticasone in children. In this study (50 children enrolled to date) healing rates of oesophagitis and symptom resolution with fluticasone were similar to those with prednisolone. For another ongoing RCT, comparing the efficacy of swallowed fluticasone with placebo for eosinophilic oesophagitis in males and females aged 3 to 21 years no results are available.

Authors' conclusions

The lack of completed RCT's makes it impossible to compare the relative benefits and harms of the wide range of medical interventions currently used for treating EO. Published case series suggest that an elemental diet, oral steroids and topical steroids all offer some benefits. However, lack of a comparison group in these studies makes it impossible to evaluate the effect of these interventions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

A systematic review of the literature did not identify any randomised controlled trials evaluating the benefits and harms of medical treatments for eosinophilic oesophagitis.

People with eosinophilic oesophagitis (EO) present with difficulty swallowing, vomiting, regurgitation, and chest and/or abdominal pain. Frequently, symptoms do not resolve with acid suppressive treatment or anti-reflux surgery. The cause of EO is unknown; however dietary and/or environmental factors may contribute to disease. In our systematic review we found no completed randomised controlled trials (RCTs) evaluating treatments for eosinophilic oesophagitis. Two RCTs are currently underway. One compares steroid spray with oral prednisolone and the other compares steroid spray with placebo.

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