Swallowed Corticosteroids Treatment

There are 2 main options when your EoE is serious enough to consider taking corticosteroids. For EoE, they are not in a pill form usually, they need to get to your esophagus, so it has to be a liquid form. The treatment is swallowed corticosteroids. There are 2 main types that are prescribed. These 2 medicines are used because there have been studies done that show they help improve the condition in the esophagus from EoE. The steroids help calm down the inflammation by reducing the reaction to the allergens.

NOTE: NO medicine has been approved by the FDA for treatment of EoE. These steroids are mainly used for the treatment of asthma and breathing allergies, but since they may have a similar improving affect on EoE they are prescribed but “dry” swallowed intending to deliver the meds to the esophagus instead of delivering them to the lungs by inhaling.

Fluticasone or “Flovent”

Flovent is an inhaler, but for EoE instead of inhaling it, you spray it then swallow it as best you can. The difficulty with Flovent is that the mist is so fine that it immediately hits the back of the throat or the inside of your mouth, and there’s no “liquid” to really swallow. So you have to try to get it down into your esophagus. Most will likely be wasted because it hits other places, but the idea is that some gets to your esophagus.

Budesonide

Budesonide comes in liquid vials that actually are meant to go into a nebulizer and inhaled. For EoE these vials are simply opened and swallowed to directly coat the esophagus. Some doctors will counsel their patients to put it in a spoon with 4 or 5 packets of Splenda, which makes a texture that could better coat and remain in the esophagus instead of going straight to the stomach.

This medicine has a greater chance of hitting the esophagus since it’s an actual vial of liquid instead of a fine mist spray like Flovent.

Warning – because these steroids hit your mouth and back of your throat, you MUST wash your mouth out with water thoroughly after taking them. This is because if left in your mouth it increases the chance of developing “Thrush” (yeast infection) in your mouth or throat. This can be a painful problem, and has to be treated by an anti-fungal medicine to get rid of it.

Considerations if Taking Corticosteroids

• Since the goal is to let these steroids coat the esophagus, do not eat or drink for at least 30 minutes after taking them.
• Pay attention to any potential side affects when taking these medicines for any extended period.
• The most common side affect is Thrush or a yeast infection in your throat or mouth. This may begin by feeling like a sore throat as if you’re getting sick, but it keeps getting worse and may feel like it’s on your tongue or in your mouth. If you feel a sore throat consult your GI as there are anti-fungal medicines that can be prescribed to deal with this condition.
• Another reported side affect could be a feeling of having a respiratory infection.
• The hope is that you can find relief enough to justify taking these medicines, at least temporarily while you find other options to improve your condition.
• These meds differ from other steroids in that they are not systemic, meaning they treat the esophagus and pass through your stomach without being absorbed into other parts of the body. Prednisone and the like are known to be systemic and produce much harsher side effects because of it. As a result, you can stop taking these corticosteroids any time you feel without having to “wean off” of them.

Hear about my experience with corticosteroids.