Safety of swallowed corticosteroids and their influence on the hypothalamic-pituitary-adrenal gland axis and on markers of bone resorption and formation in patients with eosinophilic esophagitis.

AIMS: Corticosteroids have side effects like adrenal insufficiency (AI) and bone decalcification, amongst others. Swallowed formulations appear to be les harmful. Our aim is to study the effects of orodispersable budesonide used in patients with eosinophilic esophagitis (EoE) on the hypothalamic-pituitary-adrenal axis, by using a test with higher sensitivity than measuring basal cortisol levels, and on bone resorption and formation.

METHODS

We conducted a prospective study with 20 patients with confirmed diagnosis of EoE, with no previous response to proton pump inhibitors (PPI) and no previous treatment with corticosteroids. They were given orodispersable budesonide tablets (OBT) 1 mg twice a day for 14 weeks. They were carried out physical exams, blood tests and an adrenocorticotropic hormone (ACTH) stimulation test before and after the treatment.

RESULTS

Differences in Synacthen test before and after treatment with OBT were not statistically significant, with only three patients below the baseline of 18 mcg/dL of cortisol 60 min after the administration of ACTH in the second visit. A statistically significant decrease in seric osteocalcin and bone alkaline phosphatase (BAP) was found, while other bone resorption values remained unchanged after the treatment.

CONCLUSION

This study endorses that adult patients with EoE in treatment with OBT have no risk of AI, which might simplify their management. Osteocalcin and BAP decrease could reveal corticoids systemic absorption, although its clinical relevance needs to be determined.