We performed a randomized trial to compare nebulized and viscous topical 
corticosteroid treatments for eosinophilic esophagitis (EoE). Subjects with 
incident EoE (n = 25) received budesonide 1 mg twice daily, either nebulized and 
then swallowed (NEB) or as an oral viscous slurry (OVB), for 8 weeks. Baseline 
eosinophil counts for the NEB and OVB groups were 101 and 83 (P = .62). 
Posttreatment counts were 89 and 11 (P = .02). The mucosal medication contact 
time, measured by scintigraphy, was higher for the OVB group than the NEB group 
(P < .005) and was inversely correlated with eosinophil count (R = -0.67; P = 
.001). OVB was more effective than NEB in reducing numbers of esophageal 
eosinophils in patients with EoE. OVB provided a significantly higher level of 
esophageal exposure to the therapeutic agent, which correlated with lower 
eosinophil counts.