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Randomized controlled trials comparing budesonide with placebo were identified through PRISMA and AMSTAR informed searches in PubMed, EMBASE, and Google Scholar up to January 2025, with certainty of evidence assessed using a GRADE approach. Eleven RCTs (1089 participants) showed improved histologic remission and clinical symptom outcomes, while fibrosis scores did not improve; overall adverse events were similar to placebo, with infections and transient cortisol suppression occurring more often.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/efficacy-and-safety-of-budesonide-for-eosinophilic-esophagitis-an-updated-systematic-review-and-meta-analysis/433444/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/efficacy-and-safety-of-budesonide-for-eosinophilic-esophagitis-an-updated-systematic-review-and-meta-analysis/433444.png","ImageObject",300,407,{"name":92,"@type":93},"dawugda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What does the updated review evaluate about budesonide in eosinophilic esophagitis (EoE)?","Question",{"text":113,"@type":114},"It assesses budesonide’s efficacy and safety in EoE using an updated systematic review and meta-analysis of randomized controlled trials comparing budesonide with placebo.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How effective is budesonide for histologic and clinical outcomes in EoE?",{"text":118,"@type":114},"Budesonide significantly improves histologic remission and reduces peak eosinophil counts, and it also favors clinical response and dysphagia symptom score improvement.",{"name":120,"@type":111,"acceptedAnswer":121},"What safety concerns were identified, and how should they be monitored?",{"text":122,"@type":114},"Adverse events overall were comparable to placebo, but infections occurred more frequently and transient cortisol suppression was observed; the review recommends long-term adrenal monitoring.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},433444,1791097776,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":105,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},3985747870947,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Systematic Review  \nEfficacy and safety of budesonide for eosinophilic esophagitis: an updated systematic review and meta-analysis  \nKanza Farhan, MDa , Muhammad Burhan Tariq, MDa , Muhammad Usama Shahid, MDb , Barka Sajid, MDa , Rabeya Farid, MDa , Maryam Mirza, MDa , Izere Salomon, MDc ,*, Muskan Tanveer, MDa  \nBackground: Eosinophilic esophagitis (EoE), a chronic immune-mediated inflammatory disorder, is increasingly recognized globally. Budesonide, a topical corticosteroid, is widely used for EoE; but its efficacy and safety profile require comprehensive evaluation.  \nObjective: To assess the efficacy and safety of budesonide in EoE through an updated systematic review and meta-analysis of randomized controlled trials (RCTs) .  \nMethods: Following PRISMA guidelines and AMSTAR guidelines, we searched PubMed, EMBASE, and Google Scholar for RCTs comparing budesonide with placebo in EoE patients (conception to January 2025) . A GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to rate the certainty of evidence across key outcomes. Primary outcomes included histologic response (≤15 eosinophils/high-power field), clinical symptom improvement, and safety. Data were pooled using random/fixed-effects models, with sensitivity analyses to address heterogeneity.  \nResults: Eleven RCTs (1089 participants) were included. Budesonide significantly improved histologic remission (RR: 26.85; 95% CI: 13.72–52.56; P \u003C 0.00001) and reduced peak eosinophil counts (SMD: −1 .08; 95% CI: −1.40 to 0.77; P \u003C 0.00001) . Clinical response (RR: 1.58; 95% CI: 1.03–2.42; P = 0.04) and dysphagia symptom scores (SMD: −0 .29; 95% CI: −0.49 to 0.09;  \nP = 0.004) also favored budesonide. However, fibrosis scores showed no significant improvement (P = 0.48) . Adverse events were comparable to placebo overall (RR: 1.01; 95% CI: 0.82–1.24), though infections were more frequent with budesonide (RR: 2. 14; 95% CI: 1.20–3.80; P = 0.009) . Transient cortisol suppression occurred in sensitivity analyses (SMD: −0 .41; 95% CI: −0.66 to 0. 16; P = 0.001) . Most infections were localized (e.g. , oropharyngeal candidiasis) and rarely required treatment discontinuation. Conclusion: Budesonide effectively induces histologic and clinical remission in EoE but does not reverse fibrosis. While generally safe, long-term adrenal monitoring is warranted due to cortisol suppression. GRADE evaluation suggested moderate-to-high certainty for efficacy outcomes and moderate certainty for safety outcomes. Persistent symptoms in fibrostenotic disease highlight the need for adjunct therapies. Future research should optimize dosing regimens and evaluate combination strategies.  \nKeywords: budesonide, corticosteroids, eosinophilic esophagitis, meta-analysis, randomized controlled trials  \nIntroduction  \nEosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disorder characterized by eosinophilic infiltration of the esophageal epithelium, resulting in esophageal dysfunction[1]. The prevalent clinical manifestations include dysphagia, food impaction, feeding difficulties in pediatric patients,  \naJinnah Sindh Medical University, Karachi, Pakistan, bDow University of Health Sciences, Karachi, Pakistan and cDepartment of General Medicine and Surgery, University of Rwanda, college of medicine and health sciences, Kigali, Rwanda Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Department of General Medicine and Surgery, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda. E-mail: [izesajw73@gmail.com](izesajw73@gmail.com) (I. Salomon).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and noncommercial, as long as it is passed along unchange","cbCaipOG2e2QvEoM","https://ap.wps.com/l/cbCaipOG2e2QvEoM","pdf",1888600,"English","# Background\n# Objective\n# Methods\n# Results\n# Conclusion\n# Keywords\n# Introduction\n# Highlights","[{\"question\":\"What does the updated review evaluate about budesonide in eosinophilic esophagitis (EoE)?\",\"answer\":\"It assesses budesonide’s efficacy and safety in EoE using an updated systematic review and meta-analysis of randomized controlled trials comparing budesonide with placebo.\"},{\"question\":\"How effective is budesonide for histologic and clinical outcomes in EoE?\",\"answer\":\"Budesonide significantly improves histologic remission and reduces peak eosinophil counts, and it also favors clinical response and dysphagia symptom score improvement.\"},{\"question\":\"What safety concerns were identified, and how should they be monitored?\",\"answer\":\"Adverse events overall were comparable to placebo, but infections occurred more frequently and transient cortisol suppression was observed; the review recommends long-term adrenal monitoring.\"}]","Efficacy and safety of budesonide for eosinophilic esophagitis - an updated systematic review and meta-analysis | PDF",1790664127,28]