{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:35Z","timestamp":1783491515939,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"\n Background<\/jats:title>\n Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease defined by the combination of clinical symptoms of esophageal dysfunction and histological evidence of eosinophilic infiltration (\u226515 eosinophils per high-power field [eos\/hpf]) once secondary causes have been excluded. Tissue remodelling and impaired motility cause dysphagia and food impaction. Budesonide oral suspension (BOS) is a topical corticosteroid formulated to enhance mucosal contact and reduce inflammation. This systematic review and meta-analysis evaluated the efficacy and safety of BOS in improving dysphagia and achieving histological remission in EoE.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Following the PRISMA 2020 statement, PubMed, Scopus, Web of Science, and EMBASE were searched from inception to October 14, 2024, with an update verified up to the date of submission. Randomized controlled trials (RCTs) comparing BOS (1\u20132 mg twice daily) versus placebo in pediatric or adult EoE patients treated for \u226512 weeks were included. The primary outcome was histologic remission (&lt;15 eos\/hpf). Secondary outcomes included endoscopic findings (Eosinophilic Esophagitis Endoscopic Reference Score, EREFS), patient-reported symptom severity (assessed with validated symptom instruments, including the Dysphagia Symptom Questionnaire, DSQ), and treatment-emergent adverse events. Random-effects meta-analyses were performed using the Paule\u2013Mandel estimator, and certainty of evidence was graded with GRADE. Mean difference (MD; the average between-group difference in the unit of the outcome) and odds ratio (OR) were reported with 95% confidence intervals (CI).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Four RCTs (n = 523) met the inclusion criteria. BOS significantly improved histologic outcomes versus placebo (MD = \u201354.62 eos\/hpf; 95% CI \u201368.19 to \u201341.05; I\n 2<\/jats:sup>\n = 34.3%). Endoscopic severity improved (MD = \u20131.68; 95% CI \u20133.09 to \u20130.26). Patient-reported symptom severity also improved (pooled MD = \u20133.29 points; 95% CI \u20136.17 to \u20130.40), although the contributing trials used different validated symptom instruments, so this estimate reflects a composite symptom-severity effect. Treatment-emergent adverse events, mainly oropharyngeal\/esophageal candidiasis, did not differ meaningfully between groups; serious adverse events were rare.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n BOS effectively reduces esophageal inflammation and alleviates dysphagia in EoE, supporting its use as a first-line topical therapy. The novel contribution of this synthesis is a strictly homogenous BOS-versus-placebo evidence base in which formulation, dose range, and follow-up are aligned across the four RCTs, complementing\u2014rather than duplicating\u2014broader meta-analyses that pooled heterogeneous budesonide preparations.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42025631228<\/jats:ext-link>\n , identifier CRD4202525631228.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1782316","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:56:30Z","timestamp":1783490190000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of budesonide oral suspension on dysphagia and esophageal inflammation in eosinophilic esophagitis: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Dar\u00edo S.","family":"L\u00f3pez Delgado","sequence":"first","affiliation":[{"name":"Facultad de Medicina, Universidad Cooperativa de Colombia","place":["Pasto, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Narv\u00e1ez","sequence":"additional","affiliation":[{"name":"Departamento de Pediatr\u00eda, Hospital Escuela Cesar Amador Molina","place":["Matagalpa, Nicaragua"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria L.","family":"Chapues-Andrade","sequence":"additional","affiliation":[{"name":"Facultad de Odontolog\u00eda, Enfermer\u00eda, Medicina, Universidad Cooperativa de Colombia","place":["Pasto, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda A.","family":"Matus-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de Nicaragua","place":["Managua, Nicaragua"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veraliz","family":"Gonz\u00e1lez-Hidalgo","sequence":"additional","affiliation":[{"name":"Departamento de Pediatr\u00eda, Hospital Escuela Cesar Amador Molina","place":["Matagalpa, Nicaragua"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerson","family":"Diaz-Gonzales","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Universidad San Ignacio de Loyola","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana","family":"Rivera-Lozada","sequence":"additional","affiliation":[{"name":"Vicerrectorado de Investigaci\u00f3n, Universidad Se\u00f1or de Sip\u00e1n","place":["Chiclayo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshuan J.","family":"Barboza","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Universidad Se\u00f1or de Sip\u00e1n","place":["Chiclayo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2023.44.7.20220812","article-title":"Eosinophilic esophagitis","volume":"44","author":"Alkhowaiter","year":"2023","journal-title":"Saudi Med J"},{"key":"B2","unstructured":"Epidemiology and Natural History of Eosinophilic Esophagitis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.07.009","article-title":"Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference","volume":"155","author":"Dellon","year":"2018","journal-title":"Gastroenterology"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.14920","article-title":"Eosinophilic esophagitis: a 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