BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is caused by immunologic 
reactions to ingested/inhaled allergens. The diagnosis is considered if >or=15 
eosinophils per high-powered field (eos/hpf) are detected in mucosal biopsies. 
Placebo-controlled studies have not been conducted to evaluate the safety and 
efficacy of oral viscous budesonide (OVB).
METHODS: Children with EoE were randomly assigned to groups that were given OVB 
(n=15) or placebo (n=9). Patients<5 feet and >or=5 feet tall received 1 mg and 2 
mg OVB daily, respectively. All patients received lansoprazole. Duration of 
treatment was 3 months, followed by repeat endoscopy and biopsies. Patients were 
classified as responders if their peak eosinophil counts were <or=6 eos/hpf, 
partial responders were 7-19 eos/hpf, and nonresponders were >or=20 eos/hpf. 
Baseline and post-treatment symptoms and endoscopic and histologic features were 
scored.
RESULTS: Thirteen (86.7%) children given OVB (P<.0001) and none who received 
placebo (P=.3) were classified as responders. Mean pre-/post-treatment peak 
eosinophil counts were 66.7 and 4.8 eos/hpf, respectively, in the group given 
OVB (P<.0001); they were 83.9 and 65.6 eos/hpf, respectively, in the group given 
placebo (P=.3). In the group given OVB, there were significant reductions from 
baseline values in proximal (P=.002), mid (P=.0003), and distal (P=.001) 
esophageal eosinophilia. After OVB therapy, compared with baseline, the mean 
symptom (P=.0007), endoscopy (P=.0005), and histology scores improved (P=.0035) 
significantly.
CONCLUSIONS: OVB is an effective treatment of pan-esophageal disease in children 
with EoE. OVB improves symptoms and endoscopic and histologic features. Proton 
pump inhibitor single therapy did not significantly improve esophageal 
eosinophilia or symptoms of EoE.