The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

Do Topical Corticosteroids Induce Histologic Remission 
and Improve Clinical Symptoms in Eosinophilic 
Esophagitis? - A Systematic Review and Meta-Analysis 

S Ghazaleh1*, A Ramadugu1, M Aziz1, A Renno1, S Stanley1, M Karrick1, A 
Nawras1

1Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: sami.ghazaleh@utoledo.edu

Published: 05 May 2023 

Introduction: Eosinophilic esophagitis is a chronic esophageal disease characterized histologically by 
eosinophil-predominant inflammation and clinically by symptoms related to esophageal dysfunction. 
The management of the disease commonly involves elimination diet, acid suppression, topical 
corticosteroids, and esophageal dilation. 

Methods: We conducted a systematic review and meta-analysis of studies that investigated the efficacy 
and safety of topical corticosteroids compared with placebo in eosinophilic esophagitis. We performed a 
comprehensive search in the databases of PubMed/MEDLINE, Embase, and Cochrane from inception 
through October 18, 2021. Our outcomes were histologic remission, symptomatic clinical improvement, 
and the occurrence of oral or esophageal candidiasis. The random-effects model was used. A p value 
<0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index.  

Results: Nine randomized controlled trials involving 483 patients were included in the meta-analysis. 
Compared to placebo, patients who received steroids were more likely to achieve histologic remission 
(RR 12.50, 95% CI 6.04 – 25.88, p < 0.00001, I2 = 0%) and report symptomatic clinical improvement 
(RR 1.84, 95% CI 1.02 – 3.32, p = 0.04, I2 = 64%). Oral or esophageal candidiasis was more likely to 
occur in patients who received steroids (RR 4.31, 95% CI 1.53 – 12.18, p = 0.006, I2 = 0%).  

Conclusion: Our meta-analysis demonstrated that topical corticosteroids were more effective than 
placebo in achieving histologic remission and improving clinical symptoms. However, they are more 
likely to cause oral or esophageal candidiasis. 

https://dx.doi.org/10.46570/utjms.vol11-2023-667 

https://dx.doi.org/10.46570/utjms.vol11-2023-667
mailto:sami.ghazaleh@utoledo.edu