Efficacy of proton pump inhibitor therapy for eosinophilic oesophagitis in 630 patients: results from the EoE connect registry

Abstract

Background: Proton pump inhibitors (PPIs) are the most commonly used first-line therapy for patients with eosinophilic oesophagitis (EoE). However, many aspects related to PPIs in EoE are still unknown. Aims:To assess the effectiveness of PPI therapy for EoE in real-world practice. Methods:This cross-sectional study collected data on PPI efficacy from the multicentre EoE CONNECT database. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom score; histological remission was defined as a peak eosinophil count below 15 eosinophils per high-power field. Factors associated with effectiveness of PPI therapy were identified by binary logistic regression multivariate analyses.Results: Overall, 630 patients (76 children) received PPI as initial therapy (n = 600) or after failure to respond to other therapies (n = 30). PPI therapy achieved eosinophil density below 15 eosinophils per high-power field in 48.8% and a decreased symptom score in 71.0% of patients. More EoE patients with an inflammatory rather than stricturing phenotype accomplished clinico-histological remission after PPI therapy (OR 3.7; 95% CI, 1.4-9.5); as well as those who prolonged treatment length from 8 to 12 weeks (OR 2.7; 95% CI, 1.3-5.3). After achieving clinico-histological remission of EoE, PPI dosage reduction was effectively maintained in 69.9% of patients, but tended to be less effective among those with a stricturing phenotype.Conclusions: Inflammatory EoE phenotype and treatment duration up to 12 weeks correlated with greater chance for inducing remission of EoE. A stricturing phenotype decreased response rates to PPI therapy both initially and in the long term.

Long‐term continued proton pump inhibitor use is common in patients diagnosed with eosinophilic oesophagitis despite failure of histologic response: Data from a two‐centre study

“…A recent multicentre study by Laserna-Mendieta et al examined efficacy of PPI in maintaining clinico-histologic remission in patients with EoE and found that 30% of patients experience loss of response. While loss of response with PPI is not as high as that seen with topical steroids,33 this finding reiterates the need for continued assessment of clinical benefit, particularly for patients on maintenance therapy 34. Future studies might also examine how remission obtained on topical steroids versus dietary therapy impacts the chance of patients remaining on PPI therapy.According to consensus guidelines, patients with EoE who have responded to and are maintained on PPIs should undergo routine evaluation for sustained benefit, particularly given the risk of waning effect as is seen with other EoE therapies 33,35.…”

Letter: PPI in EoE – more questions than answers. Authors' reply

“…To relieve concerns about the validity of our results, 1,2 DSS has been used in several studies, [3][4][5] including one carried out by Miehlke,6 because no validated instrument is available to assess symptoms in EoE patients in most European languages. DSS assesses frequency, intensity and duration of dysphagia; total scores range from 1 to 15.…”

“…The authors' declarations of personal and financial interests are unchanged from those in the original article. 2…”

“…This article is linked to Laserna-Mendieta et al and Miehlke et al papers. To view these articles, visit https://doi.org/10.1111/apt.15957 and https://doi.org/10.1111/apt.16194 Alfredo J. Lucendo 1,2,3 Ángel Arias 2,3,4 Emilio J. Laserna-Mendieta 1,…”

Letter: PPIs in EoE—More questions than answers

“…In this sense, we propose that the "real" effectiveness of PPI therapy in adult EoE patients should be regarded as limited unless proven otherwise by randomised placebo-controlled trials. Stephan Miehlke 1,2 Ulrike von Arnim 3 Stephen Attwood 4…”