Esophageal Eosinophilic Infiltration Responds to Proton Pump Inhibition in Most Adults

Molina–Infante, Javier; Ferrando-Lamana, Lucía; Ripoll, Cristina; Hernández-Alonso, Moisés; Mateos, José; Fernandez–Bermejo, Miguel; Dueñas, Carmen; Fernandez‐Gonzalez, Nuria; Quintana, E; González-Núñez, María

doi:10.1016/j.cgh.2010.09.019

Cited by 349 publications

(330 citation statements)

References 40 publications

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“…Nonetheless, four studies considered remission within the range of 0 to ≤5 eosinophils/hpf, 42, 43, 44, 45 and five studies considered remission as having ≤15 eosinophils/hpf 46, 47, 48, 49, 50…”

Section: Resultsmentioning

confidence: 99%

“…Of the 22 studies selected from European centers, 12 studies (55%) considered values within the range 11 to ≤15 eosinophils/hpf 17, 36, 37, 38, 39, 46, 47, 53, 54, 55, 56, 57, 58 as histological remission, and 4 studies (23%) defined histological remission as less than 5 or ≤ 5 eosinophils/hpf 30, 33, 42, 45. Strikingly, all studies conducted in Switzerland used a more stringent and consistent end‐point of <5 eosinophils /hpf to identify cases of histological remission 28, 59, 60…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinophils per microscopic high‐powered field [hpf]) remain the most common end‐point used to define response. Yet, the threshold for defining “response” and “remission” are ill‐defined among consensus guidelines and may vary from study to study. We conducted a systematic literature review of articles on eosinophilic esophagitis, published between January 2007 and November 2017, considering histological remission as the primary outcome. We abstracted treatment information and definitions of histological remission or response. A comparison of definitions of histological remission across and within institutions was performed. A total of 61 articles were included in this review, with approximately 60% of the studies published from centers in the United States. Histological definitions of remission of EoE ranged from 0 to ≤20 eosinophils/hpf. The most stringent criteria, ranging from 0 to ≤5 eosinophils/hpf, were commonly used in interventional trial studies that examined the effects of new treatments. We found remarkable variability in definitions between studies, treatment types, and regions. Age or epidemiological distribution of study subjects did not influence the criteria for histological remission. Clinical and histological improvements are important measures of the effects of treatment. Histological findings, the most objective measure of treatment, should provide an optimal method for comparing the effectiveness of various treatments. Yet, our findings suggest a lack of consistent remission criteria in published studies. Considering these inconsistencies, it is difficult to compare the effectiveness of various treatments.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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“…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.…”

mentioning

confidence: 84%

Letter: PPI‐responsive oesophageal eosinophilia – from initial skepticism to consistent prospective data; authors' reply

Achem

Talley

2013

Aliment Pharmacol Ther

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“…Importantly, there is an expansion of the evidence regarding the concept of PPI-REE as a potentially distinct entity from GERD and EoE that also requires clinical follow-up. The original consensus guidelines recommended an 8-week trial of high-dose PPI (e.g., twice daily), based on case report evidence that esophageal eosinophilia in some patients may respond to this treatment, and to rule out GERD as a contributing factor [23][24][25][26][27]. It is currently appreciated that there may be at least two distinct populations of patients with esophageal eosinophilia, which has prompted a shifting of the nomenclature-those with abnormal pH studies and GERD with high numbers of eosinophils and those with normal pH and eosinophilia responsive to PPI [2 • ].…”

Section: Updates On Clinical Guidelines For Diagnosing and Managing Eoementioning

confidence: 99%

Non-IgE Medicated Food Allergy: Eosinophilic Esophagitis Update on the Pathogenesis, Clinical Features, and Management of Eosinophilic Esophagitis in Children

Greenhawt

Aceves

2014

Curr Pediatr Rep

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Eosinophilic esophagitis (EoE) is a chronic allergic disorder of increasing worldwide prevalence. Diagnosis and management require upper gastrointestinal endoscopy with biopsy. Therapeutic strategies in children and adults include empiric and testing-based elimination diets as well as topical esophageal corticosteroids. The last 12 months have provided a number of insights including updated diagnostic/management guidelines, the role of PPI therapy, and an understanding that EoE disease mechanisms rely on basophils and mast cells in addition to eosinophils. Novel diagnostic techniques have been described and include the esophageal string test and a molecular gene array panel. In addition, new techniques for assessing esophageal rigidity have been reported. In this review, we summarize the most impactful findings in EoE over the last 12-15 months.

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Esophageal Eosinophilic Infiltration Responds to Proton Pump Inhibition in Most Adults

Cited by 349 publications

References 40 publications

Systematic review of histological remission criteria in eosinophilic esophagitis

Systematic review of histological remission criteria in eosinophilic esophagitis

Letter: PPI‐responsive oesophageal eosinophilia – from initial skepticism to consistent prospective data; authors' reply

Non-IgE Medicated Food Allergy: Eosinophilic Esophagitis Update on the Pathogenesis, Clinical Features, and Management of Eosinophilic Esophagitis in Children

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