Proton pump inhibitor therapy reverses endoscopic features of fibrosis in eosinophilic esophagitis

Type 2 Inflammation in Eosinophilic Esophagitis: From Pathophysiology to Therapeutic Targets

“…Thus, systemic steroids are currently reserved for critical patients with severe dysphagia or significant weight loss (Gonzalez-Cervera and Lucendo, 2016;Lucendo et al, 2017). Swallowed topical corticosteroids, mainly fluticasone propionate and budesonide, currently represent one of the most effective first-line therapies for EoE in both children and adults (Navarro et al, 2021;Rokkas et al, 2021).…”

“…PPIs are an established first-line therapy for EoE, with a reported efficacy in 50% of pediatric and adult patients ( Lucendo et al, 2016 ; Laserna-Mendieta et al, 2020 ; Navarro et al, 2021 ). Beyond their blocking effect of gastric acid secretion, PPIs have been demonstrated to be able to downregulate the esophageal gene expression of eotaxin-3, IL-5, and IL-13 similarly to topical steroids ( Molina-Infante et al, 2014 ) and to inhibit ICAM-1 and VCAM-1 expression and enhance barrier function ( Spergel et al, 2018 ).…”

Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference

“…These are distinguished from esophageal dilation, which directly improves rings, strictures, and symptoms of dysphagia, but may not improve with acute treatment of inflammation. 66 Although some data indicate that medical and dietary therapy can improve fibrosis (seen histologically) [67][68][69] or esophageal caliber (as measured by the functional luminal imagine probe), 70 the preponderance of data is related to the decrease in eosinophilic inflammation and histologic severity. 71,72 Therefore, when assessing endoscopic features, seeing an improvement in edema, exudates, and furrows is an important visual clue that treatments are effective (eg, moving from pretreatment EREFS of E1R0Ex2F1S0 to post-treatment EREFS of E0R0Ex0F0S0).…”

Eosinophilic esophagitis: Immune mechanisms and therapeutic targets

“…The functional relevance of BZH and ANO1 expression and relationship to human EoE is unclear. Shoda et al identified an EoE endotype (EoE Endotype 3) 55 that was associated with a fibrostenotic (rings, narrowing, strictures) phenotype and the highest degree of endoscopic and histological severity. Molecular analyses revealed that ANO1 was one of two discriminatory genes (ANO1 and UPK1A) to provide 98% PPV of EoE endotype 3 suggesting a link between ANO1 and the fibrostenotic and histologic phenotype 5 .…”