MedWire News: Children with the food pipe condition eosinophilic oesophagitis benefit from either "systemic" steroids taken by mouth or 'topical' steroids in the form of a spray, but stopping treatment can cause a relapse of symptoms, say US researchers.

Eosinophilic oesophagitis is a type of allergic disease that causes swelling of the food pipe, or oesophagus. The condition can cause severe heartburn, nausea, vomiting and weight loss, and children with the disease often refuse to eat because of swallowing difficulties.

Dr Sandeep Gupta and colleagues from the James Whitcomb Riley Hospital for Children in Indianapolis, Indiana, explain that around one in 2000 US children are affected by eosinophilic oesophagitis, and that the prevalence of the disease is growing.

"A child will often continue to suffer in silence if this disease is left untreated," said Dr Gupta.

He added that although steroid treatment is affective at reducing swelling and other symptoms of eosinophilic oesophagitis, it is not known whether systemic or topical steroids are best for treating children with the condition.

To investigate, Dr Gupta and team studied 80 children with eosinophilic oesophagitis who received either systemic or topical steroids for 4 weeks and were then gradually weaned off the drugs over a further 20 weeks.

After 4 weeks, all of the children receiving systemic steroids and all but one of those receiving topical steroids were free of symptoms. However, by week 24 of the study, when all the children had stopped taking steroids, 45% of the participants had relapsed and had started to experience symptoms again.

There was no significantly difference in relapse rates between children taking systemic or topical steroids.

Dr Gupta and team conclude: "This trial... showed that as primary therapy both systemic and topical corticosteroids showed success in achieving initial [symptom] improvement."

But they add that the high relapse rate after stopping treatment indicates that lower doses of steroids may be needed over the long term as a 'maintenance' therapy to prevent symptoms recurring.

The research is published in the journal Clinical Gastroenterology and Hepatology.