A recent study shows similar clinical, endoscopic and histologic findings between eosinophilic esophagitis (EoE) and proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) (Aliment Pharmacol There 2014; 39: 603-08 -thanks to Seth Marcus for this reference).

The authors used two databases: one from Walter Reed and one from the Swiss EoE database.  All of these patients were >/=18 years.  Response to PPI was defined as achieving less than 15 eos/hpf and a 50% decrease from baseline following at least 6-weeks of PPI treatment.

Demographics: 63 EoE patients, 40 PPI-REE, mean age 40 years (75% male, 89% Caucasian).

Findings:

• Similar dysphagia 97% vs. 100% (in EoE and  of PPI-REE cohorts)
• Similar food impaction 43% vs. 35% (in EoE and  of PPI-REE cohorts)
• Similar heartburn 33% vs. 32% (in EoE and  of PPI-REE cohorts)
• Similar duration of symptoms: 6.0 years vs 5.8 years (in EoE and  of PPI-REE cohorts)
• Similar endoscopic findings too: rings 68% in both groups, furrows 70% in both groups, strictures 49% vs 30% (in EoE and  of PPI-REE cohorts)
• Similar histology: proximal esophagus 39 vs 38 eos/hpf and distal esophagus 50 vs 43 eos/hpf

Take-home message: EoE and PPI-REE are very similar in presentation and indistinguishable without a PPI trial.

Related blog posts:

• Nexium versus Fluticasone for EoE | gutsandgrowth
• EoE -Journal Club (Part 1) | gutsandgrowth

• EoE -Journal Club (Part 2) | gutsandgrowth

• EoE: Drugs, Diets, Dilatation and PPI-REE | gutsandgrowth