– Eosinophilic Esophagitis (EoE) is a chronic allergen-mediated disease of the esophagus. Pharmacologic treatment has largely relied on repurposing corticosteroids. Ciclesonide (CIC) is a corticosteroid for the treatment of asthma with biochemical properties that improve topical potency.
This study aimed to determine if CIC decreased clinicopathological features of EoE.
– We performed a retrospective cohort study of EoE patients treated with CIC at a pediatric hospital from 2010-2019. Data was extracted from the electronic health record. Patients were included for analysis who were prescribed CIC with pre- and post-CIC endoscopic and histological data available.
281 patients were treated with CIC and 81 met criteria for inclusion. Use of CIC was associated with reduced symptoms including dysphagia (p<0.001), abdominal pain (p<0.001), vomiting (p=0.01), heartburn (p=0.02), and behavior changes (p=0.02). Average composite EREFS scores decreased from 2.54 to 1.37 (p<0.001) with improvement in exudates, edema, and furrows (all p<0.001). Peak eosinophil counts decreased from 48 to 23 eosinophils/HPF (p<0.001). Forty-three patients (53%) achieved remission (<15 eosinophils/HPF). Esophageal Candida was reported in one patient. Fasting morning cortisol concentrations were low in 10 of 31 patients tested. Six of these 10 patients had abnormal ACTH stimulation testing, 5/6 diagnosed with adrenal insufficiency (AI) prior to transition to CIC and 3/6 with subsequent normalization of adrenal function on CIC therapy.
– EoE patients treated with CIC experienced significant reductions in clinicopathological features of EoE. CIC can be considered an alternative therapy in patients with known AI or at risk of developing AI.

Copyright © 2021. Published by Elsevier Inc.

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