The third article for our journal club: Aliment Pharmacol Ther 2013; 37: 1157-64.

This study involved a literature search which identified 10 articles which described the impact of proton pump inhibitor therapy for suspected eosinophilic esophagitis.  In total, these articles describe 258 patients (152 children and 106 adults).  Five of the studies were retrospective series.  The others included two randomized controlled trials, one randomized noncontrolled trial, and two prospective series.

Results: after PPI treatment, a clinical response was noted in 69% overall and histologic remission was evident in a mean of 44%.  Histologic remission was lower in children (23%-40%).  In two adult studies, both randomized controlled trials, PPI therapy (esomeprazole 40 mg/day) outperformed topical steroids (fluticasone 440 mcg bid); histologic remission was seen in 33% with PPI in both trials compared with 15% and 19% with fluticasone.

Key points in discussion:

• PPI trial “is mandatory not only to confirm the presence of EoE, but to evaluate for PPI responsiveness.”  Yet, in surveys, …”only one-third of physicians thought it is necessary to initiate a PPI trial before diagnosing EoE.”
• No clinical, endoscopic, histologic features nor pH testing “have demonstrated capacity to predict response to PPI therapy.”
• PPI-REE “occurs in at least one-third of patients with suspected EoE, with response rates lower in children.”  Adults may have a higher response due to coexisting gastroesophageal reflux disease.

Related blog entry: gutsandgrowth | Pediatric Gastroenterology