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Oral viscous budesonide

Craig C Reed, Claire Fan, Nathaniel Koutlas, Zoe Stefanadis, Swathi Eluri, Nicholas J Shaheen, Evan S Dellon
Aim: Because no approved medications exist for eosinophilic esophagitis (EoE), patients must use off-label drugs or create their own formulations. We assessed the efficacy of a standardized compounded budesonide suspension for treatment of EoE. Materials and methods: We conducted a retrospective cohort study of EoE patients at the University of North Carolina treated with compounded budesonide dispensed by a specialty compounding pharmacy. Outcomes (symptomatic global response [yes/no], endoscopic response [% with individual findings], and histologic response [absolute eosinophil count; % with <15 eos/hpf])were assessed after the initial and last treatment in our system...
2018: HSOA journal of gastroenterology & hepatology research
Craig C Reed, Anca M Safta, Shadi Qasem, M Angie Almond, Evan S Dellon, Elizabeth T Jensen
BACKGROUND: Few studies have examined combined or alternating treatment algorithms in eosinophilic esophagitis. AIMS: We conducted a retrospective cohort study to ascertain the efficacy and adherence to a combined and alternating treatment approach with topical corticosteroids and 2-food elimination diet for pediatric EoE. METHODS: Patients were prescribed a 2-food elimination diet (milk and soy) and topical corticosteroid (fluticasone or oral viscous budesonide) for 3 months, after which the steroid was discontinued and 2-food elimination diet continued for 3 months...
January 29, 2018: Digestive Diseases and Sciences
Eitan Rubinstein, Elizabeth E Hait, Paul D Mitchell, John J Lee
BACKGROUND: Eosinophilic esophagitis (EoE) is a clinicopathologic disorder characterized histologically by esophageal eosinophilia. Oral viscous budesonide (OVB) is an effective treatment with remission rates reported between 55% and 87%; however, topical corticosteroids are associated with increased risk of candidal esophagitis and adrenal suppression. Attempts to decrease the daily dose of topical steroids have resulted in disease relapse. The objective of this study was to determine whether or not reducing the frequency of OVB administration would be effective in controlling esophageal eosinophilia in children and adolescents...
March 2018: Journal of Pediatric Gastroenterology and Nutrition
Jacqueline M Fable, Marina Fernandez, Susan Goodine, Trudy Lerer, Wael N Sayej
BACKGROUND: Eosinophilic esophagitis (EoE) is treated with dietary modification and/or pharmacologic management with swallowed topical steroids. Swallowed fluticasone propionate (FP) and oral viscous budesonide (OVB) have proven to be effective in resolving symptoms and reversing histologic changes in children and adults with EoE. There are minimal comparative studies between the 2 agents. OBJECTIVE: The aim of the study was to retrospectively compare endoscopic and histologic outcomes after FP versus OVB therapy in children with EoE in our center...
January 2018: Journal of Pediatric Gastroenterology and Nutrition
Alexandra Ahmet, Eric I Benchimol, Ellen B Goldbloom, Janice L Barkey
BACKGROUND: Adrenal suppression (AS), a glucocorticoid (GC) side effect associated with significant morbidity, is well described related to inhaled corticosteroid therapy for asthma. Swallowed topical glucocorticoid therapy is the main pharmacotherapy treatment for eosinophilic esophagitis (EoE) and therefore children with EoE are potentially at increased risk of AS. METHODS: In this prospective cohort study, we included children and youth <18 years diagnosed with EoE and treated with swallowed fluticasone or oral viscous budesonide for more than 1 month...
2016: Allergy, Asthma, and Clinical Immunology
Luca Bertelli, Giovanni Di Nardo, Daniele Zama, Giulia Bardasi, William Morello, Riccardo Masetti, Tamara Belotti, Maria Luisa Forchielli, Arcangelo Prete, Andrea Pession
Oral chronic graft versus host disease (cGVHD) is often refractory to systemic therapies. Additional topical treatment is commonly required. The potency of the agent, the vehicle and formulation in which it is delivered are all critical factors in determining the effectiveness of topical therapies. High potency of budesonide, combined with its very low bioavailability when absorbed through mucosal surfaces, increased the potential role in topical application for oral cGVHD. Viscous formulation increases mucosal contact time resulting in a greater decrease in mucosal inflammation...
November 2016: Journal of Pediatric Hematology/oncology
Salvatore Oliva, Danilo Rossetti, Paola Papoff, Antonio Tiberti, Paolo Rossi, Sara Isoldi, Jorge Amil Dias, Sandra Lucarelli, Salvatore Cucchiara
OBJECTIVES: Oral viscous budesonide is a recent therapeutic option for eosinophilic oesophagitis (EoE) compared with dietary restriction and inhaled steroids. This single-centre, open-label, not blinded study aims to evaluate the efficacy and safety of a new, preprepared oral viscous budesonide suspension (PVB) in children and adolescents with EoE. METHODS: We treated 36 children with PVB (29 boys; median age 12 years) with EoE diagnosed according to European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines...
February 2017: Journal of Pediatric Gastroenterology and Nutrition
Juhee Lee, Michelle Shuker, Terri Brown-Whitehorn, Antonella Cianferoni, Laura Gober, Amanda Muir, Ritu Verma, Chris Liacouras, Jonathan M Spergel
No abstract text is available yet for this article.
July 2016: Journal of Allergy and Clinical Immunology in Practice
Jody N Hefner, Robin S Howard, Robert Massey, Miland Valencia, Derek J Stocker, Katherine Q Philla, Matthew D Goldman, Cade M Nylund, Steve B Min
BACKGROUND: Topical steroids prepared as oral viscous slurries have become common in the treatment of eosinophilic esophagitis. Esophageal mucosal contact time correlates with clinical and histologic improvement. AIM: To compare the mucosal contact time of alternative oral viscous budesonide (OVB) slurries with the conventional sucralose OVB. METHODS: A blinded randomized crossover trial investigating esophageal clearance of three OVB slurry preparations was done on healthy adults...
June 2016: Digestive Diseases and Sciences
Shira Harel, Brenden E Hursh, Edmond S Chan, Vishal Avinashi, Constadina Panagiotopoulos
We sought to determine the prevalence of adrenal suppression (AS) in children with eosinophilic esophagitis treated with oral viscous budesonide (OVB). This was a retrospective review of a quality assurance initiative, whereby all children in our center treated with OVB for ≥3 months were referred over an 18-month time frame for endocrine assessment including 1 μg adrenocorticotropic hormone stimulation test. Fourteen of 19 children complied with the referral; of these 14 children, 6 (43%) had suboptimal stimulated cortisol (range 343-497 nmol/L, mean [±SD] 424...
August 2015: Journal of Pediatric Gastroenterology and Nutrition
Javier Molina-Infante, Alfredo J Lucendo
This review aims to summarize evolving evidence on topical steroid (TS) therapy for eosinophilic esophagitis (EoE). Currently, we still use "off-label" TS, originally designed for bronchial or intranasal delivery. Direct oral administration (i.e., oral viscous budesonide) achieves better histological results than the aerosolized swallowed route, due to longer mucosal contact time. High-dose fluticasone (880 μg bid) has recently shown higher cure rates in children and adults. Steroid resistance is present in around 25-40% of patients...
June 2015: Gastroenterología y Hepatología
Andrea Zanini, Sophie Guez, Simona Salera, Giorgio Farris, Anna Morandi, Valerio Gentilino, Ernesto Leva, Francesca Manzoni, Maria Angela Pavesi, Susanna Esposito, Francesco Macchini
BACKGROUND: Esophageal and pharyngeal problems are common in the majority of patients with epidermolysis bullosa (EB). Repeated blister formation and ulceration, coupled with chronic inflammation, result in scarring and development of esophageal strictures. OBJECTIVE: This study aimed to evaluate whether oral viscous budesonide (OVB) was useful for treating esophageal structures in six pediatric patients (aged 8-17 years) with EB who were affected by dysphagia and esophageal strictures...
October 2014: Paediatric Drugs
Eitan Rubinstein, John J Lee, Ari Fried, Tanya Logvinenko, Peter Ngo, Douglas McDonald, Elizabeth J Hait
OBJECTIVES: Oral viscous budesonide (OVB) using Splenda as a delivery vehicle has become an attractive therapeutic option for children with eosinophilic esophagitis (EoE). Many families are wary of giving the artificial sweetener in high doses to their children. The aim of the present study was to determine whether OVB mixed with Neocate Nutra, a hypoallergenic nutritional supplement, is at least as efficacious as OVB mixed with Splenda at healing EoE. METHODS: Our institutional review board approved a retrospective chart review of patients with well-documented EoE treated with OVB at the Boston Children's Hospital Eosinophilic Gastrointestinal Disorder program between June 2008 and June 2013...
September 2014: Journal of Pediatric Gastroenterology and Nutrition
Emily M Contreras, Sandeep K Gupta
Swallowed fluticasone and oral viscous budesonide are effective first-line therapies for eosinophilic esophagitis in children. Side effects are minimal without evidence of Cushing syndrome, as seen in treatment with systemic corticosteroids. New studies on alternative delivery systems and different corticosteroids (eg, ciclesonide) are encouraging. As knowledge of corticosteroids in eosinophilic esophagitis expands, newer questions continue to arise concerning dose, delivery, and choice of corticosteroids; long-term adverse effects; and maintenance therapies...
June 2014: Gastroenterology Clinics of North America
Patricia D Jones, Stephan Moll, Evan S Dellon
Eosinophilic esophagitis is a chronic immune-mediated disease characterized by infiltration of the esophageal mucosa with eosinophils and concomitant esophageal dysfunction. Though there are well-described associations between certain chronic inflammatory conditions and venous thromboembolism, there have been no reports of venous thromboembolism occurring in eosinophilic esophagitis. We report the case of a 33-year-old man with severe eosinophilic esophagitis resulting in recurrent esophageal strictures who was unresponsive to oral viscous budesonide therapy, and who developed an isolated pulmonary embolism in the absence of risk factors for venous thromboembolism...
January 2013: Case Reports in Gastroenterology
Eyal Zur
Eosinophilic esophagitis is a clinicopathologic disease isolated to the esophagus. It is caused by immunologic reactions to ingested and inhaled allergans. Symptoms include regurgitation, vomiting, pain, anorexia, and dysphagia. Endoscopy with biopsy is currently the only reliable diagnostic test for eosinophilic esophagitis. The disease should remit with treatments of dietary exclusion, topical corticosteroids, or both. Oral viscous budesonide is one of the promising options of topical corticosteroid to treat eosinophilic esophagitis...
July 2012: International Journal of Pharmaceutical Compounding
Evan S Dellon, Arif Sheikh, Olga Speck, Kimberly Woodward, Ann B Whitlow, Jessica M Hores, Marija Ivanovic, Allen Chau, John T Woosley, Ryan D Madanick, Roy C Orlando, Nicholas J Shaheen
We performed a randomized trial to compare nebulized and viscous topical corticosteroid treatments for eosinophilic esophagitis (EoE). Subjects with incident EoE (n = 25) received budesonide 1 mg twice daily, either nebulized and then swallowed (NEB) or as an oral viscous slurry (OVB), for 8 weeks. Baseline eosinophil counts for the NEB and OVB groups were 101 and 83 (P = .62). Posttreatment counts were 89 and 11 (P = .02). The mucosal medication contact time, measured by scintigraphy, was higher for the OVB group than the NEB group (P < ...
August 2012: Gastroenterology
D L Francis, A Foxx-Orenstein, A S Arora, T C Smyrk, K Jensen, S L Nord, J A Alexander, Y Romero, D A Katzka
BACKGROUND: The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy. AIM: To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia. METHODS: We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results...
January 2012: Alimentary Pharmacology & Therapeutics
R Dohil, S S Aceves, M A Dohil
No abstract text is available yet for this article.
June 2011: Journal of Pediatric Gastroenterology and Nutrition
Glenn T Furuta
PURPOSE OF REVIEW: Over the course of the last year, a number of studies have brought new insights into the clinical presentation, pathogenesis, and treatment of eosinophilic esophagitis, some of which will be summarized here. RECENT FINDINGS: This swell of research and clinical need resulted in revision of the 2007 Consensus Recommendations. In addition, new insights into key clinicopathological features including symptoms such as feeding dysfunction and histological quantification of eosinophil extracellular granules are presented...
July 2011: Current Opinion in Gastroenterology
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