This week our Eosinophilic Esophagitis (EoE) journal club is meeting. The first article had previously been reviewed on this blog: SFED works for EoE! | gutsandgrowth.
The second article examines the “Effect of Proton Pump Inhibitor on Esophageal Eosinophilia” (JPGN 2013; 56: 166-72). PPI responsive esophageal eosinophilia (PPI-REE) has also been discussed previously on this blog (EoE: Drugs, Diets, Dilatation and PPI–REE | gutsandgrowth); this article adds additional information to this subject and highlights the possibility of transient PPI-REE.
Design: retrospective review of 204 children with EoE (criteria included ≥15 dos/hpf) over an 11 year time span. Only 35 subjects met the criteria of having an endoscopy before and after an exclusive 8-week trial of PPI (1-2 mg/kg/day).
Results: 8 of 35 subjects had clinical response and 7 had biopsy-confirmed response to PPIs ( 23%). In five patients with durable response, mean eosinophil count decreased from 92 to 5 eos/hpf. In addition, eosinophil peroxidase index (EPX) declined from 39.2 to 14.6. Two patients experienced relapse despite initial PPI-responsiveness. Clinical and histologic relapse occurred at 17 and 23 months respectively. However, of the 5 subjects who did not experience relapse, average followup reported in study was only 8 months.
Study limitations: small number of patients, limited geographical area, tertiary medical center study, retrospective study, uncertain compliance with therapy, and variable dosing of PPIs
Take-home points:
- No clinicopathologic features distinguished patients with PPI-REE from EoE patients or patients with transient PPI-REE. Yet, 23% (8/35) of initial cohort showed resolution of symptoms and 7/35 had resolution of esophageal inflammation after PPI treatment.
- Potential explanations for transient PPI-REE: lack of PPI adherence, missed detection of EoE after PPI trial (patchy disease), variation in allergenic exposure, diminished effect of PPIs over time, fluctuation in EoE disease course unrelated to PPI usage
Related blog entries:
- CHOOSING TOPICAL THERAPY FOR EOE | GUTSANDGROWTH
- GUIDELINES FOR EOSINOPHILIC ESOPHAGITIS | GUTSANDGROWTH
- EOSINOPHILIC ESOPHAGITIS –SIX FOOD GROUP DIET | GUTSANDGROWTH
- LOOK OF IMPROVEMENT ON AN EOE DIET | GUTSANDGROWTH
- STRING TEST | GUTSANDGROWTH
- LOOKING BETTER OR FEELING BETTER IN EOE? | GUTSANDGROWTH
- THE UNDISCOVERED COUNTRY | GUTSANDGROWTH
Also, for those of you who read all the way to the bottom, here’s a link to a culturally significant (aka viral video) advertisement that I thought was amusing (potty humor):
gutsandgrowth 
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