Introduction

A study published in the Journal of Paediatric Gastroenterology and Nutrition provides valuable insights into the development and resolution of adrenal insufficiency (AI) in paediatric patients with eosinophilic oesophagitis (EoE) using swallowed topical steroids (STS).

Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated oesophageal disease characterised by symptoms of oesophageal dysfunction and histologically by eosinophil-predominant inflammation.

Methods

The researchers conducted a retrospective case-control study of paediatric EoE subjects in a single tertiary care centre. The subjects were treated with STS for at least three months and diagnosed with AI based on a peak stimulated cortisol level of <18 µg/dL (500 nmol/L).

The team collected data on steroid forms and doses and endoscopy at the time of AI diagnosis and AI resolution or the last known evaluation. For analysis, they converted steroid formulations to a fluticasone-equivalent dose​.

Results

The study identified 32 EoE subjects with AI, and 20 had AI resolution, including 12 who remained on a lower dose of STS. 

Eight of the 32 patients were also treated with extended-release budesonide (ER budesonide*), leading to a 7-fold higher total daily steroid dose, and thus were analysed separately.

When the 24 cases not on ER budesonide were compared to the 81 controls, no difference was found in the STS dose or total daily steroid dose, although the inhaled steroid dose had marginal significance.

Peak eosinophil counts tended to increase when STS doses were decreased, except in subjects on ER budesonide at the time of AI diagnosis​.

Conclusion

The study concluded that altering the total daily steroid regimen can lead to the resolution of AI in patients with EoE. However, this may come at the expense of disease control.

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* extended-release ER budesonide is not commonly used as an EoE treatment as this is usually in the form of slow-release capsules or tablets and therefore is targeting the gut below the oesophagus, unlike the EoE budesonide treatments administered via orodispersible tablets or the repsules used for the slurry mix targeting the oesophagus area.