Evidence map›Paper›PMID 29508432›Full record

SynthesisAlimentary pharmacology & therapeutics2018

Systematic review: adrenal insufficiency secondary to swallowed topical corticosteroids in eosinophilic oesophagitis.

H Philpott, M K Dougherty, C C Reed, M Caldwell, D Kirk, D J Torpy, E S Dellon

Registry-linked trialOpen access · bronzeAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Alimentary pharmacology & therapeutics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04416217 (Adrenal Suppression in Pediatric Eosinophilic Esophagitis Treated With Topical Steroids - A Multicenter, Prospective, Observational Safety Study), which is not on this map. Cited by 30 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 3 pooled it
8.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04416217 completednot on this mapstarted 2019, after this paper: background citation

Adrenal Suppression in Pediatric Eosinophilic Esophagitis Treated With Topical Steroids - A Multicenter, Prospective, Observational Safety Study

TypeobservationalSponsorRabin Medical CenterRan2019 to 2024Enrolled55ConditionsEosinophilic Esophagitis
3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 71 citations in OpenAlex.

  1. Efficacy of Biological and Steroid Therapies in Adolescent and Adult Patients With Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis With Meta-Regression.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026
    Pooled it
  2. Pooled it
  3. Guideline
  4. Trial
  5. Review
  6. Article
  7. Article
  8. Drugs in focus: Budesonide and its role in paediatric gastrointestinal disorders.Journal of pediatric gastroenterology and nutrition · 2026
    Review
  9. Article
  10. Article
  11. Article
  12. Review
  13. Eosinophilic esophagitis for the advanced practice provider.iGIE : innovation, investigation and insights · 2023
    Article
  14. Review
  15. Article
  16. Article
  17. Review
  18. Review
  19. Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

H PhilpottDepartment of Gastroenterology, Lyell McEwin and Modbury Hospitals, Northern Adelaide Local Health Network (NALHN), University of Adelaide, Adelaide, South Australia, Australia.ORCID 0000-0002-1973-6355
M K DoughertyDivision of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
C C ReedDivision of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
M CaldwellDivision of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
D KirkDivision of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
D J TorpyDepartment of Endocrinology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia.
E S DellonDivision of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
University of North Carolina at Chapel Hill · USModbury Hospital · AURoyal Adelaide Hospital · AU

Funding

DIGESTIVE DISEASES EPIDEMIOLOGY TRAINING PROGRAMT32DK007634 · NIDDK · UNIV OF NORTH CAROLINA CHAPEL HILL · PI ROBERT S. SANDLER · 1990 to 2026
$7.4M
Budesonide versus fluticasone for treatment of eosinophilic esophagitisR01DK101856 · NIDDK · UNIV OF NORTH CAROLINA CHAPEL HILL · PI DELLON, EVAN SAMUEL · 2014 to 2018
$1.7M
NIDDK NIH HHS R01 DK101856NIDDK NIH HHS T32 DK007634
6 · The paper itself

Abstract

backgroundSwallowed topical corticosteroids are prescribed for eosinophilic oesophagitis (EoE), but there is a theoretical risk of adrenal insufficiency from their use.

aimsTo determine if the use of topical corticosteroids to treat EoE is associated with the development of adrenal insufficiency.

methodWe conducted a systematic review of the published literature from January 1, 1950 to April 1, 2017 using Pubmed, Embase, Web of Science and Cochrane Central. Studies and meeting abstracts were included that described patients with EoE who received swallowed topical corticosteroids and any investigation for adrenal insufficiency.

resultsThe search revealed 1610 unique publications, and 17 met inclusion criteria. There were 7 randomised controlled trials (RCTs), 6 prospective observational studies, 3 retrospective observational studies, and 1 case report. Cortisol measurements were performed on 596 individuals with EoE who received topical corticosteroids. Adrenal testing was abnormal, as defined by each study, in 94/596 patients (crude rate of 15.8%). Only 2 studies were considered to have a low risk of bias, being randomised controlled trials that estimated adrenal insufficiency in the active treatment and placebo groups, before and after treatment. None of the seven randomised controlled trials demonstrated statistically significantly different rates of adrenal insufficiency between topical corticosteroid and placebo over treatment intervals of 2-12 weeks.

conclusionTopical corticosteroids were associated with adrenal insufficiency in a minority of patients. Most cases came from uncontrolled observational studies, with widely varying definitions of adrenal insufficiency. Longer follow-up and larger controlled studies are needed to quantify the risk of adrenal insufficiency with maintenance topical corticosteroid therapy in EoE.

Indexed as

Administration, OralAdrenal Cortex HormonesAdrenal InsufficiencyEosinophilic EsophagitisHumansObservational Studies as TopicRandomized Controlled Trials as TopicAdrenal Cortex Hormones

Identifiers

PMID29508432
PMCPMC5867261
OpenAlexW2793611936

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.