pulmicort and Esophagitis

Eosinophilic esophagitis (EoE) is caused by immunologic reactions to ingested/inhaled allergens. The diagnosis is considered if >or=15 eosinophils per high-powered field (eos/hpf) are detected in mucosal biopsies. Placebo-controlled studies have not been conducted to evaluate the safety and efficacy of oral viscous budesonide (OVB).. Children with EoE were randomly assigned to groups that were given OVB (n=15) or placebo (n=9). Patients<5 feet and >or=5 feet tall received 1 mg and 2 mg OVB daily, respectively. All patients received lansoprazole. Duration of treatment was 3 months, followed by repeat endoscopy and biopsies. Patients were classified as responders if their peak eosinophil counts were or=20 eos/hpf. Baseline and post-treatment symptoms and endoscopic and histologic features were scored.. Thirteen (86.7%) children given OVB (P<.0001) and none who received placebo (P=.3) were classified as responders. Mean pre-/post-treatment peak eosinophil counts were 66.7 and 4.8 eos/hpf, respectively, in the group given OVB (P<.0001); they were 83.9 and 65.6 eos/hpf, respectively, in the group given placebo (P=.3). In the group given OVB, there were significant reductions from baseline values in proximal (P=.002), mid (P=.0003), and distal (P=.001) esophageal eosinophilia. After OVB therapy, compared with baseline, the mean symptom (P=.0007), endoscopy (P=.0005), and histology scores improved (P=.0035) significantly.. OVB is an effective treatment of pan-esophageal disease in children with EoE. OVB improves symptoms and endoscopic and histologic features. Proton pump inhibitor single therapy did not significantly improve esophageal eosinophilia or symptoms of EoE.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Administration, Oral; Adolescent; Anti-Inflammatory Agents; Biopsy; Budesonide; Child; Child, Preschool; Dosage Forms; Double-Blind Method; Drug Therapy, Combination; Eosinophilia; Esophagitis; Esophagoscopy; Esophagus; Female; Fibrosis; Genotype; Humans; Immunohistochemistry; Infant; Lansoprazole; Male; Mucous Membrane; Phenotype; Placebo Effect; Polymorphism, Single Nucleotide; Promoter Regions, Genetic; Proton Pump Inhibitors; Transforming Growth Factor beta1; Treatment Outcome

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by dense tissue eosinophilia; it is refractory to proton pump inhibitor therapy. EoE affects all age groups but most frequently individuals between 20 and 50 years of age. Topical corticosteroids are effective in pediatric patients with EoE, but no controlled studies of corticosteroids have been reported in adult patients.. We performed a randomized, double-blind, placebo-controlled trial to evaluate the effect of oral budesonide (1 mg twice daily for 15 days) in adolescent and adult patients with active EoE. Pretreatment and posttreatment disease activity was assessed clinically, endoscopically, and histologically. The primary end point was reduced mean numbers of eosinophils in the esophageal epithelium (number per high-power field [hpf] = esophageal eosinophil load). Esophageal biopsy and blood samples were analyzed using immunofluorescence and immunoassays, respectively, for biomarkers of inflammation and treatment response.. A 15-day course of therapy significantly decreased the number of eosinophils in the esophageal epithelium in patients given budesonide (from 68.2 to 5.5 eosinophils/hpf; P < .0001) but not in the placebo group (from 62.3 to 56.5 eosinophils/hpf; P = .48). Dysphagia scores significantly improved among patients given budesonide compared with those given placebo (5.61 vs 2.22; P < .0001). White exudates and red furrows were reversed in patients given budesonide, based on endoscopy examination. Budesonide, but not placebo, also reduced apoptosis of epithelial cells and molecular remodeling events in the esophagus; no serious adverse events were observed.. A 15-day course of treatment with budesonide is well tolerated and highly effective in inducing a histologic and clinical remission in adolescent and adult patients with active EoE.

Topics: Administration, Oral; Adolescent; Adult; Budesonide; Dose-Response Relationship, Drug; Double-Blind Method; Endoscopy, Gastrointestinal; Eosinophilia; Esophagitis; Female; Follow-Up Studies; Glucocorticoids; Humans; Intestinal Mucosa; Male; Retrospective Studies; Treatment Outcome; Young Adult

Radiation esophagitis is a common side effect of therapeutic radiotherapy. In this case report, we describe a patient with a complete remission of the esophagitis after therapy with an oro-dispersible budesonide formulation.. Eine Strahlenösophagitis im Rahmen einer therapeutischen Radiotherapie ist weiterhin eine relativ häufige Komplikation. In diesem Fallbericht beschreiben wir eine Patientin, bei der unter einer Therapie mit orodispersiblem Budesonid eine Strahlenösophagitis ohne erkennbare Residuen abheilen konnte.

Topics: Administration, Oral; Anti-Inflammatory Agents; Budesonide; Esophagitis; Glucocorticoids; Humans; Radiation Injuries; Remission Induction; Treatment Outcome

Topics: Adalimumab; Anti-Bacterial Agents; Anti-Inflammatory Agents; Budesonide; Colonoscopy; Colostomy; Constriction, Pathologic; Crohn Disease; Disease Management; Embolization, Therapeutic; Endoscopy, Digestive System; Esophageal Diseases; Esophagitis; Female; Gastric Artery; Gastrointestinal Hemorrhage; Hematemesis; Humans; Infliximab; Magnetic Resonance Imaging; Middle Aged; Omeprazole; Proton Pump Inhibitors; Rectovaginal Fistula; Recurrence; Sigmoid Diseases; Tumor Necrosis Factor Inhibitors

Topics: Budesonide; Combined Modality Therapy; Dilatation; Esophageal Stenosis; Esophagitis; Female; Glucocorticoids; Humans; Lymphocytosis; Middle Aged

Topics: Adult; Antibodies, Monoclonal, Humanized; Budesonide; Deglutition Disorders; Endoscopy, Digestive System; Esophagitis; Gastrointestinal Agents; Glucocorticoids; Heartburn; Humans; Lymphocytes; Male; Omeprazole; Proton Pump Inhibitors; Treatment Failure; Treatment Outcome

Topics: Budesonide; Deglutition Disorders; Esophagitis; Humans; Leukocytosis; Male; Middle Aged; Off-Label Use; Suspensions

Here we describe the first case of symptomatic Lichen planus oesophagitis that was successfully treated with topical budesonide. Lichen planus is a chronic inflammatory disorder of the skin and mucous membranes which is in some cases associated with oesophageal involvement and dysphagia. So far, anecdotal treatment approaches consisted of systemic steroids, retinoids or immunosuppressives. Our patient received oral budesonide suspension 2×1 mg per day for 8 weeks, followed by 2 × 0.5  mg for 3 months. At the end of treatment we observed a complete symptomatic, endoscopic and histological remission, which lasted for at least further 6 months after termination of treatment.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Esophagitis; Female; Humans; Lichen Planus; Middle Aged; Treatment Outcome

Esophageal remodeling occurs in eosinophilic esophagitis (EE) patients but whether the components of remodeling in the subepithelium are reversible by administration of topical oral corticosteroids is unknown.. We quantitated the degree of lamina propria remodeling in esophageal biopsies obtained before and after at least 3 months of therapy with budesonide in 16 pediatric EE subjects. In addition, we investigated whether corticosteroid therapy modulated vascular activation (expression of VCAM-1; level of interstitial edema), TGFbeta(1) activation (levels of TGFbeta(1), phosphorylated Smad2/3), and performed a pilot analysis of a polymorphism in the TGFbeta(1) promoter in relation to EE subjects who had reduced remodeling with budesonide therapy.. EE subjects were stratified based on the presence (n = 9) or absence (n = 7) of decreased epithelial eosinophilia following budesonide. Patients with residual eosinophil counts of

Topics: Administration, Oral; Administration, Topical; Adolescent; Budesonide; Child; Child, Preschool; Eosinophilia; Esophagitis; Female; Fibrosis; Genetic Predisposition to Disease; Glucocorticoids; Humans; Male; Mucous Membrane; Polymorphism, Single Nucleotide; Promoter Regions, Genetic; Transforming Growth Factor beta1; Vascular Cell Adhesion Molecule-1

Eosinophilic esophagitis (EE) is a disorder characterized typically by pan-esophageal eosinophilia. We evaluate a palatable, long-acting topical corticosteroid preparation for the treatment of EE.. This is a retrospective analysis of symptoms, endoscopic and histologic findings, efficacy, and safety of treatment in children with EE receiving oral viscous budesonide. Response to therapy was determined histologically by the number of eos/hpf. Patients were classified by histology into responders (0-7 eos/hpf), partial responders (8-23 eos/hpf), and nonresponders (>/=24 eos/hpf). A symptom score (max. 14) and an EE endoscopy score (max. 8) were used to compare data.. In 20 children (mean age 5.5 yr, median age 4.1 yr) the mean highest eosinophil count was 87 eos/hpf (range 30-170) before and 7 eos/hpf (range 0-50, P < 0.0001) after therapy. There were 16 (80%) responders, 1 partial responder, and 3 nonresponders. Commonest pretreatment symptoms were nausea, vomiting, pain, and heartburn. The mean symptom score fell from 4.4 to 0.8 (P < 0.0001) and the mean endoscopy score from 3.6 to 0.8 (P < 0.0001). No significant adverse events were reported. Morning cortisol levels were within normal limits.. Topical viscous budesonide is a safe and effective therapy for EE in young children.

Topics: Administration, Oral; Adolescent; Budesonide; Child; Child, Preschool; Eosinophilia; Esophagitis; Female; Follow-Up Studies; Glucocorticoids; Humans; Infant; Male; Retrospective Studies; Suspensions; Treatment Outcome; Viscosity

Topics: Asthma; Budesonide; Child; Eosinophilia; Esophagitis; Fibrosis; Glucocorticoids; Humans; Male

Topics: Abdominal Pain; Administration, Oral; Anti-Inflammatory Agents; Budesonide; Child; Eosinophilia; Esophagitis; Female; Humans; Hypersensitivity; Male; Suspensions

Studies have demonstrated that budesonide is effective in the treatment of active Crohn's disease. Due to its extensive hepatic metabolism, budesonide has much lower adverse events compared to prednisolone. Consequently, the low systemic availability restricts its application to Crohn's disease of the terminal ileum and the colon. Esophageal ulceration is a rare complication of Crohn's disease. This article describes the case of a young lady who presented at the age of 16 with active Crohn's disease of the terminal ileum and the colon without dysphagia or pain in the chest. Her disease was successfully treated with prednisolone for almost two years. Because of weight gain, acne, and moon face she was switched to budesonide. A few days later she presented with intractable pain of the esophagus, dysphagia, and inability to eat. Endoscopy demonstrated aphthous ulcerations of the esophagus and the histology was compatible with Crohn's disease. After two weeks of treatment with prednisolone all symptoms resolved and at follow-up gastroscopy ulcers had disappeared.

Topics: Adolescent; Budesonide; Crohn Disease; Esophagitis; Female; Humans; Peptic Ulcer; Prednisolone; Treatment Outcome

Idiopathic eosinophilic esophagitis is an underdiagnosed disease with typical endoscopic findings, which have not been well described.. Charts and pathology reports at two tertiary care centers from June 1993 to April 2002 were reviewed to describe the endoscopic findings of this disease and to correlate them with clinical characteristics. Eight patients were identified as having eosinophilic esophagitis based on clinical symptoms and pathology reports.. Soft and subtle ring(s) in the esophagus were found in 7 of 8 patients. In 3 of 8 patients, the esophagus appeared rigid. Mucosal rents occurred with simple passage of the endoscope in 5 of 8 patients. One patient developed a perforation after simple passage of the endoscope. Endoscopic findings can be normal or very subtle in these patients, and the findings can easily be missed during endoscopy. Tearing of the esophagus can occur with simple passage of the endoscope or biopsy even in the absence of overt rings. A minimum of 8 weeks of medical therapy (proton pump inhibitor, histamine antagonists, immunosuppressants) should be undertaken before considering dilation because of the high risk involved with the procedure and the good response to medical therapy.. We recommend considering dilation only in patients with eosinophilic esophagitis who do not respond to medical therapy and have rings that appear to be obstructing the lumen.

Topics: Adult; Anti-Inflammatory Agents; Azathioprine; Biomarkers; Biopsy; Budesonide; Catheterization; Deglutition Disorders; Diagnosis, Differential; Dilatation, Pathologic; Endoscopy, Digestive System; Eosinophilia; Eosinophils; Esophageal Perforation; Esophagitis; Esophagus; Female; Follow-Up Studies; Gastric Mucosa; Gastroesophageal Reflux; Gastrointestinal Motility; Histamine H1 Antagonists; Histamine H2 Antagonists; Humans; Immunosuppressive Agents; Male; Prednisone; Proton Pump Inhibitors; Proton Pumps; Recurrence; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome