Resolution of remodeling in eosinophilic esophagitis correlates with epithelial response to topical corticosteroids

Allergy. 2010 Jan;65(1):109-16. doi: 10.1111/j.1398-9995.2009.02142.x. Epub 2009 Oct 1.


Background: Esophageal remodeling occurs in eosinophilic esophagitis (EE) patients but whether the components of remodeling in the subepithelium are reversible by administration of topical oral corticosteroids is unknown.

Methods: We quantitated the degree of lamina propria remodeling in esophageal biopsies obtained before and after at least 3 months of therapy with budesonide in 16 pediatric EE subjects. In addition, we investigated whether corticosteroid therapy modulated vascular activation (expression of VCAM-1; level of interstitial edema), TGFbeta(1) activation (levels of TGFbeta(1), phosphorylated Smad2/3), and performed a pilot analysis of a polymorphism in the TGFbeta(1) promoter in relation to EE subjects who had reduced remodeling with budesonide therapy.

Results: EE subjects were stratified based on the presence (n = 9) or absence (n = 7) of decreased epithelial eosinophilia following budesonide. Patients with residual eosinophil counts of <or=7 eosinophils per high power field in the epithelial space (responders) demonstrated significantly reduced esophageal remodeling with decreased fibrosis, TGFbeta(1) and pSmad2/3 positive cells, and decreased vascular activation in association with budesonide therapy. Responders were more likely to have a CC genotype at the -509 position in the TGFbeta(1) promoter.

Conclusions: Reductions in epithelial eosinophils following budesonide therapy were associated with significantly reduced esophageal remodeling.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Administration, Topical
  • Adolescent
  • Budesonide / administration & dosage*
  • Child
  • Child, Preschool
  • Eosinophilia / drug therapy
  • Eosinophilia / etiology
  • Eosinophilia / pathology
  • Esophagitis / drug therapy*
  • Esophagitis / genetics
  • Esophagitis / immunology
  • Female
  • Fibrosis / drug therapy
  • Fibrosis / etiology
  • Genetic Predisposition to Disease
  • Glucocorticoids / administration & dosage*
  • Humans
  • Male
  • Mucous Membrane / drug effects*
  • Mucous Membrane / immunology
  • Mucous Membrane / pathology
  • Polymorphism, Single Nucleotide
  • Promoter Regions, Genetic
  • Transforming Growth Factor beta1 / biosynthesis
  • Transforming Growth Factor beta1 / drug effects
  • Transforming Growth Factor beta1 / genetics
  • Vascular Cell Adhesion Molecule-1 / biosynthesis
  • Vascular Cell Adhesion Molecule-1 / drug effects


  • Glucocorticoids
  • TGFB1 protein, human
  • Transforming Growth Factor beta1
  • Vascular Cell Adhesion Molecule-1
  • Budesonide