Predictors of Response to Proton Pump Inhibitor Therapy among Children with Significant Esophageal Eosinophilia

Letter: PPI‐responsive oesophageal eosinophilia – from initial skepticism to consistent prospective data; authors' reply

“…Current thinking suggests that eosinophilic oesophagitis is an immune-mediated, antigen-driven disorder; 3 thus, diet elimination and/or corticosteroid therapy would seem the fitting therapeutic strategy. 4 There is now, however, confirmatory evidence available, including our study 2 and their data, 5,6 as well as other studies, [7][8][9][10][11][12][13][14][15] that symptomatic patients with oesophageal eosinophilic infiltration, which is phenotypically indistinguishable from eosinophilic oesophagitis, respond to PPI therapy. In further support of Drs.…”

“…Studies validating these findings come from geographically diverse centres across both sides of the Atlantic 2, 5, 9 and Asia. 10 The benefits are noted in both children 7,8,12 and adult populations. 2,5 The magnitude of the response rates is robust (at least 33%, and as much as 75%).…”

“…2,5 The magnitude of the response rates is robust (at least 33%, and as much as 75%). 2,[5][6][7]15 The improvement seems unrelated to the type of PPI used (at least two PPIs have been examined, namely omeprazole and rabeprazole). 2,5 Finally, higher PPI dose does not necessarily result in superior response rates, 6 although only one study has examined the concept of higher doses.…”

Eosinophilic Esophagitis–More than Two Decades of Progress

“…High dose PPI with anti-reflux measures are useful in treating patients with esophageal eosinophilia secondary to GERD, PPI-REE, and EoE [45,46]. In patients found to have esophageal eosinophilia it is recommended to give a PPI once or twice daily for 8 to 12 weeks in adults and 1 mg/kg per dose, twice daily for 8 to 12 weeks in children.…”

Eosinophilic Esophagitis” (EoE) Do we Need Diagnostic Guideline Update??

“…(40my BID for 2 weeks). The focus on exclusion of PPI-REE was because it can easily be misdiagnosed as EoE and because it was found to constitute up to 30% of EoE family [9,10].…”