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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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EOSINOPHILIC ESOPHAGITIS AND TOPICAL CORTICOSTEROIDS: IN SEARCH OF A MINIMUM EFFECTIVE DOSE

David Pina Trincão; Miguel Paiva; Elena Finelli; Sara Prates; Isabel Afonso; José Cabral; Paula Leiria Pinto

1- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
2- Unidade de Gastroenterologia Pediátrica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;

Allergy school on Eosinophilic Esophagitis, Roterdão, 16-18 de Março de 2018
- Apresentação sob a forma de poster; publicação de resumo
- Reunião Internacional

Introduction: Treatment guidelines of Eosinophilic Esophagitis (EoE) advocate the use of topical corticosteroids (TCS) alongside dietary measures. Specific formulation, dosage and duration of treatment with TCS are not well established in literature.
Objective: To assess the efficacy of TCS on EoE treatment and evaluate the diseases’ progression according to its suspension or dose reduction.
Methods: We performed a retrospective analysis of patients diagnosed with EoE between 2006 and 2015, who were treated with TCS. Treatment baseline was swallowed fluticasone propionate [PF] 500 mcg bid, administered through a pressured metered dose inhaler, for a minimum duration of 3 months. We evaluated efficacy defined as clinical and histological resolution as well as disease evolution, taking into account treatment suspension or maintenance.
Results: Of 53 patients with EoE who started treatment with TCS we analyzed 47 who kept follow-up. Of these, 37 were boys. Median age of symptom onset was 8 years (minimum 6 months, maximum 15 years), and median age of diagnosis was 8.4 years (minimum 2 years, maximum 17 years). Clinical and histological resolution was achieved in 94% (n=44). Treatment suspension in the latter group (n=34) held a relapse rate of 100%. In 10 patients, daily dose reduction was attempted. In 7 patients clinical and histological remission were maintained with lower dose, namely, PF 500 mcg/day in 4 and 250 mcg/day in 3 patients. In the other 3 patients who relapsed with PF 500 mcg/day, remission was once again achieved after up-dosing to 1000 mcg/day.
Conclusions: TCS efficacy for EoE treatment is elevated and dose dependent, apparently. Our results suggest that it is possible to reduce maintenance dose in a significant number of patients. In patients with EoE treated with TCS, minimum effective dose for disease control should be evaluated in order to reduce the risks of side effects without compromising disease control.

Palavras Chave: Eosinophilic Esophagitis, topical corticosteroids