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

Abstract

Background and Aims: Treatment paradigms for proton pump inhibitors (PPIs) in eosinophilic oesophagitis (EoE) are evolving. We aimed to determine patterns of longterm PPI use after EoE diagnosis in PPI histologic nonresponders. Methods: We conducted a retrospective review at University of Colorado (UCH) and University of North Carolina (UNC) of EoE patients who were histologic nonresponders to PPIs. Data were extracted from electronic medical records related to demographics, PPI use and reasons for continuing or stopping PPI. Results: Of 67 patients in the UCH cohort, PPIs were initially discontinued in nine (13%). Of 58 remaining on PPI, 48% were not instructed to discontinue therapy and 26% continued for symptom improvement. Of 675 patients at UNC, PPI was stopped in 185 (27%). Of patients remaining on PPI, 15% were not told to discontinue therapy and 62% were continued for symptom improvement. At last contact, >50% of patients remained on PPI at both centres with most common reasons for continuation being symptom improvement and not telling patients to discontinue. In the UNC cohort, clinical features associated with remaining on PPI included children younger than 18 years (P = .01), males (P < .001), heartburn symptoms (P < .001) and hiatal hernia (P = .004). Patients with dysphagia were less likely to remain on PPIs (P < .001). Conclusions: Long-term PPI use is common in EoE patients even without histologic response. Failure to instruct patients to discontinue therapy was a common reason for long-term use, thus PPI use should be revisited in all EoE patients to confirm clinical benefit. How to cite this article: DeLay K, Tappata M, Huang KZ, et al. 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.

Effect of Proton Pump Inhibitor Treatment in “PPI Non-responsive” Patients with Eosinophilic Esophagitis

“…While we did not see a change in reports of dysphagia, we did see a decrease in heartburn. This would be consistent with findings from a prior study showing that a large proportion of PPI non-responders remained on PPI treatment, and the reason in more than a quarter was because of perceived symptom improvement [40]. It is possible this is because of treatment of concomitant GERD with EoE, but our present study design does not allow us to investigate this.…”

Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases

“…Dose reduction of PPI to the lowest effective dose can then be attempted following histologic and clinical remission 19 . Long‐term histologic and clinical response rates to PPI therapy (mean follow‐up 3.6 ± 2.9 years) have been described at 60% and 64%, respectively 133,134 …”