A Japanese case series of 12 patients with esophageal eosinophilia

Abstract

The endoscopic recognition of linear furrows, concentric rings, and white exudates is important in the diagnosis of eosinophilic esophageal inflammation. In a subset of patients this condition improves clinicopathologically with PPI treatment, and typical EoE, as strictly defined by unresponsiveness to PPI, appears to be a rather rare condition.

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%).…”

Proton Pump Inhibitors Therapy for Eosinophilic Esophagitis

“…Moreover, both diseases affect predominantly males on their 2 nd -4 th decade and indeed coexist (38-56%) as evidenced by cohorts with persistent symptoms and esophageal eosinophilia on PPI therapy in spite of abnormal pH testing [12,[32][33]. In the first consensus EoE guidelines, it was initially established that EoE could be distinguished from GERD by persistent esophageal eosinophilia despite adequate high-dose acid suppressive therapy [2].…”

“…Evolving research [6][7][8][9][10][11][12][13] and updated 2011 guidelines [1], as mentioned above, have highlighted that a clear distinction between GERD and EoE may be difficult, even more upon the existence of a novel EoE phenotype, the PPI-responsive esophageal eosinophilia. These patients are undistinguishable from EoE patients in clinical, endoscopic and histological terms.…”

“…As such, pathologic acid exposure is not predictive of PPI response, raising the possibility of a new potential PPI-responsive EoE phenotype without GERD. Abe et al [12] reported lately the first retrospective case series from Japan involving 12 patients. 6 out of 12 were treated with PPIs, of whom 3 patients (50%) achieved clinical and histological remission.…”