Clinicopathologic Analysis of Proton Pump Inhibitor-Responsive Esophageal Eosinophilia in Korean Patients

Abstract

Background/AimsProton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized form of eosinophilic esophagitis (EoE) that responds to PPI therapy. It remains unclear whether PPI-REE represents a subphenotype of gastroesophageal reflux disease, a subphenotype of EoE, or its own distinct entity. The aim was to evaluate the clinicopathologic features of PPI-REE.MethodsSix patients were diagnosed with PPI-REE based on symptoms, endoscopic abnormalities, esophageal eosinophilia with ≥15 eosinophils/high-power field, and a response to PPI treatment. Symptoms and endoscopic and pathological findings were evaluated.ResultsThe median follow-up duration was 12 months. Presenting symptoms included dysphagia, heartburn, chest pain, foreign body sensation, acid reflux, and sore throat. All patients had typical endoscopic findings of EoE such as esophageal rings, linear furrows, nodularity, and whitish plaques. Three patients had a concomitant allergic disorder, and one had reflux esophagitis. Four patients exhibited elevated serum IgE, and five had positive skin prick tests. All patients experienced symptomatic resolution within 4 weeks and histologic resolution within 8 weeks after starting PPI therapy. There was no symptomatic recurrence.ConclusionsPPI therapy induced rapid resolution of symptoms and eosinophil counts in patients with PPI-REE. Large-scale studies with long-term follow-up are warranted.

Similarities and differences among eosinophilic esophagitis, proton-pump inhibitor-responsive esophageal eosinophilia, and reflux esophagitis: comparisons of clinical, endoscopic, and histopathological findings in Japanese patients

“…Since PPIs show few clinically important or serious side effects, they are widely used to treat the disease [35]. In Asian countries, cases of PPI-responsive esophageal eosinophilia have been reported to be around 50 % of the cases with esophageal eosinophilia [36][37][38][39]. In this study, 59 % of the cases responded to PPI administration, confirming previous reports from many countries.…”

Development of urinary incontinence in a 7-year old boy after therapy with proton pump inhibitors and complete resolution of his clinicopathologic features of eosinophilic esophagitis after H2-receptor antagonist treatment: A case report

“…This recently recognized entity of esophageal eosinophilia is defined as PPI-responsive esophageal eosinophilia (PPI-REE) (6,7). Retrospective studies have demonstrated that 39 % to 71 % of children and adults with EEI have PPI-REE (13). At the moment, it is not clear whether it represents a part of EoE spectrum, GERD spectrum or a completely independent disease.…”

Proton Pump Inhibitor Induction of Gastric Cobblestone-like Lesions in the Stomach

“…Tissue with a cobblestone-like appearance has been observed in patients with pathologic conditions of the esophagogastrointestinal tract, including those with eosinophilic esophagitis, H. pylori gastritis, gastric MALT lymphoma, and Crohn's disease ( 9 - 12 ). The new type of gastric lesion observed in this study is in line with these previous findings, indicating that gastritis, whether due to PPI use or other conditions, can induce a cobblestone-like appearance in gastric tissues.…”