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Drug May Retain Eosinophilic Esophagitis Remission

Esophageal remodeling indicated by esophageal thickness shows improvement with budesonide

THURSDAY, May 26 (HealthDay News) -- Use of low-dose budesonide may be more effective than placebo for maintaining eosinophilic esophagitis (EoE) in clinical and histological remission, according to a study published in the May issue of Clinical Gastroenterology and Hepatology.

Alex Straumann, M.D., from the University Hospital Basel in Switzerland, and colleagues examined the long-term efficacy of budesonide to maintain EoE in remission. A total of 28 patients were randomly allocated to placebo or treatment with 0.25 mg budesonide twice daily for 50 weeks. Activity was assessed pre- and post-treatment clinically, endoscopically, histologically, immunohistologically, and endosongraphically. End points were the ability of treatment to maintain histologic remission, the efficacy of symptom control, prevention of tissue remodeling, and safety.

The investigators found that the esophageal eosinophil load increased significantly from 0.4 to 31.8 eosinophils per high-power field in patients given budesonide, and the load increased significantly more in patients treated with placebo, from 0.7 to 65.0 eosinophils per high-power field. Symptom scores were similar in both groups of patients. Reduced noneosinophilic markers of inflammation, epithelial cell apoptosis, and remodeling events were seen with budesonide treatment, but not placebo. Based on endosonography, patients were seen to have significantly thickened esophageal walls compared to control individuals. Budesonide treatment was correlated with significantly reduced mucosal thickness, but not epithelial thickness. There were no serious adverse events.

"Low-dose budesonide is more effective than placebo in maintaining EoE in histologic and clinical remission. Signs of esophageal remodeling showed a trend toward normalization," the authors write.

Two of the study authors disclosed financial relationships with AstraZeneca, which provided support for the study.

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