Systemic steroids have a role in treating esophageal strictures in pediatric eosinophilic esophagitis.

Background: The role of systemic steroids in the treatment of esophageal strictures in children with Eosinophilic Esophagitis (EoE) is poorly defined.
Aims: To describe a cohort of children with EoE-associated esophageal strictures responding to systemic steroids.
Methods: Retrospective review of medical records of children with EoE and moderate (<9 mm) to severe (<6 mm) strictures, who responded clinically and endoscopically to systemic steroids.
Results: Twenty children (median age 10.6 ± 4.2 years; 17 males) from nine centers in six countries were included in the analysis; 16 had moderate and four, severe strictures; 18 had dysphagia or bolus impaction; median diagnostic delay was 8 months (IQR 3.5-35). Eighteen patients received oral systemic steroids (mean dose 1.4 mg/kg/day) for a median of 4 weeks, while two initially received IV steroids. All patients showed clinical improvement and 15/20 became asymptomatic. Stricture resolution at endoscopy was found in 19/20, while histological resolution of EoE (<15 eos/hpf) in 13/20. Only minor side effects were reported: hyperphagia (10/20); weight gain (5/20); hyperactivity (2/20) and acne (1/20). Esophageal dilation was required in 3/20 patients during a median follow-up of 48.5 months (IQR 26.7-73.2).
Conclusion: Children with EoE and esophageal strictures, may benefit from the use of a short course of systemic steroids, avoiding mechanical dilation.
Competing Interests: Declaration of Competing Interest Manuscript title: Systemic Steroids Have a Role in Treating Esophageal Strictures in Pediatric Eosinophilic Esophagitis List of coauthors: Assaf Hoofien, Francesca Rea, Maria do Céu Espinheira, Jorge Amil Dias, Claudio Romano, Salvatore Oliva, Marcus Karl-Heinz Auth, Tsili Zangen, Nicolas Kalach, Gloria Domínguez-Ortega, Paola De Angelis Noam Zevit. This study was supported by an unconditional gift to the research fund of Dr. Noam Zevit at Schneider Medical Center by Mrs. Martha White, in loving memory of Dr. Seymor White and Dr. Judah White. Dr. Noam Zevit reports receiving consultation fees from Adare Pharmaceuticals and Dr. Falk Pharma ltd. All other authors report no relevant conflicts of interest.
(Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)