High Prevalence of Response to Proton‐pump Inhibitor Treatment in Children With Esophageal Eosinophilia

Gutiérrez-Junquera, Carolina; Fernández‐Fernández, Sonia; Cilleruelo, María Luz; Rayo, Ana; Echeverría, Luis; Quevedo, Sergio; Bracamonte, Teresa; Román, Enriqueta

doi:10.1097/mpg.0000000000001019

Cited by 96 publications

(105 citation statements)

References 32 publications

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“…In the children in the present study, remission was much lower after treatment with high-dose PPIs than in a previously published study, in which 68% of patients achieved remission after treatment with esomeprazole, with sustained remission in 78% after lowering the dose by half [8]. In contrast, our results are much worse and may be explained by the use of different PPIs.…”

Section: Conflicts Of Interestcontrasting

confidence: 56%

Eosinophilic Esophagitis: Treatment With Different Doses of Omeprazole in Children Under 16 Years

Torrijos

Palencia

Miranda

et al. 2018

J Investig Allergol Clin Immunol

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Section: Conflicts Of Interestcontrasting

confidence: 56%

Eosinophilic Esophagitis: Treatment With Different Doses of Omeprazole in Children Under 16 Years

Torrijos

Palencia

Miranda

et al. 2018

J Investig Allergol Clin Immunol

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“…[31] In three recent prospective studies, 35% to 47% of adult and pediatric patients achieved histologic remission (defined by < 5 eos/HPF) on PPI therapy. [15,32,33] Of note, response to PPI therapy increased up to 50%[30], 57%[32] and 68%[33] when histological remission was redefined as < 15 eos/HPF.…”

Section: The Efficacy Of Ppi Therapy In Patients With Suspected Eoementioning

confidence: 99%

“…[33,35–36]. As for adults, the first long-term follow-up multicentre study including 75 PPI-REE patients demonstrated that the majority of patients (73%) maintained histological remission 1 year after tapering dosage to the lowest effective clinical dose.…”

Section: The Efficacy Of Ppi Therapy In Patients With Suspected Eoementioning

confidence: 99%

Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis

Molina–Infante

Bredenoord

Cheng

et al. 2015

Gut

290

216

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Consensus diagnostic recommendations to distinguish gastro-oesophageal reflux disease (GORD) from eosinophilic oesophagitis (EoE) by response to a trial of proton pump inhibitors (PPI) unexpectedly uncovered an entity called “PPI-responsive oesophageal eosinophilia” (PPI-REE). PPI-REE refers to patients with clinical and histologic features of EoE that remit with PPI treatment. Recent and evolving evidence, mostly from adults, shows that PPI-REE and EoE patients at baseline are clinically, endoscopically and histologically indistinguishable, and have significant overlap in terms of features of Th2 immune-mediated inflammation and gene expression. Furthermore, PPI therapy restores oesophageal mucosal integrity, reduces Th2 inflammation and reverses the abnormal gene expression signature in PPI-REE patients, similar to the effects of topical steroids in EoE patients. Additionally, recent series have reported that EoE patients responsive to diet/topical steroids may also achieve remission on PPI therapy. This mounting evidence supports the concept that PPI-REE represents a continuum of the same immunologic mechanisms that underlie EoE. Accordingly, it seems counterintuitive to differentiate PPI-REE from EoE based on a differential response to PPI therapy when their phenotypic, molecular, mechanistic, and therapeutic features cannot be reliably distinguished. For patients with symptoms and histologic features of EoE, it is reasonable to consider PPI therapy not as a diagnostic test, but as a therapeutic agent. Due to its safety profile, ease of administration and high response rates (up to 50%), PPI can be considered a first-line treatment, before diet and topical steroids. The reasons why some EoE patients respond to PPI, while others do not, remain to be elucidated.

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“…Nonetheless, four studies considered remission within the range of 0 to ≤5 eosinophils/hpf, 42, 43, 44, 45 and five studies considered remission as having ≤15 eosinophils/hpf 46, 47, 48, 49, 50…”

Section: Resultsmentioning

confidence: 99%

“…Of the 22 studies selected from European centers, 12 studies (55%) considered values within the range 11 to ≤15 eosinophils/hpf 17, 36, 37, 38, 39, 46, 47, 53, 54, 55, 56, 57, 58 as histological remission, and 4 studies (23%) defined histological remission as less than 5 or ≤ 5 eosinophils/hpf 30, 33, 42, 45. Strikingly, all studies conducted in Switzerland used a more stringent and consistent end‐point of <5 eosinophils /hpf to identify cases of histological remission 28, 59, 60…”

Section: Resultsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinophils per microscopic high‐powered field [hpf]) remain the most common end‐point used to define response. Yet, the threshold for defining “response” and “remission” are ill‐defined among consensus guidelines and may vary from study to study. We conducted a systematic literature review of articles on eosinophilic esophagitis, published between January 2007 and November 2017, considering histological remission as the primary outcome. We abstracted treatment information and definitions of histological remission or response. A comparison of definitions of histological remission across and within institutions was performed. A total of 61 articles were included in this review, with approximately 60% of the studies published from centers in the United States. Histological definitions of remission of EoE ranged from 0 to ≤20 eosinophils/hpf. The most stringent criteria, ranging from 0 to ≤5 eosinophils/hpf, were commonly used in interventional trial studies that examined the effects of new treatments. We found remarkable variability in definitions between studies, treatment types, and regions. Age or epidemiological distribution of study subjects did not influence the criteria for histological remission. Clinical and histological improvements are important measures of the effects of treatment. Histological findings, the most objective measure of treatment, should provide an optimal method for comparing the effectiveness of various treatments. Yet, our findings suggest a lack of consistent remission criteria in published studies. Considering these inconsistencies, it is difficult to compare the effectiveness of various treatments.

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High Prevalence of Response to Proton‐pump Inhibitor Treatment in Children With Esophageal Eosinophilia

Cited by 96 publications

References 32 publications

Eosinophilic Esophagitis: Treatment With Different Doses of Omeprazole in Children Under 16 Years

Eosinophilic Esophagitis: Treatment With Different Doses of Omeprazole in Children Under 16 Years

Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis

Systematic review of histological remission criteria in eosinophilic esophagitis

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