Long-term efficacy of proton pump inhibitors as a treatment modality for eosinophilic esophagitis

Thakkar, Kisan; Fowler, Mark R.; Keene, Staci; Iuga, Alina; Dellon, Evan S.

doi:10.1016/j.dld.2022.03.006

Cited by 12 publications

(6 citation statements)

References 45 publications

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“…We did not observe endoscopic improvement in esophageal rings, strictures, narrowing, or need for dilation after PPI treatment. This is consistent with a recent study of long-term treatment with PPIs where fibrotic changes persisted [16]. However, we also saw less lamina propria fibrosis histologically after PPI, which would be consistent with other reports [42], though we must interpret this finding with caution as less than half of our subjects had subepithelial stroma present for evaluation.…”

Section: Discussionsupporting

confidence: 93%

“…J Gastrointestin Liver Dis, March 2023 Vol. 32 No 1: [15][16][17][18][19][20][21][22] Multiple studies support PPI effectiveness and mechanisms as a treatment modality for EoE [13,16,17]. Beyond acidsuppressive effects, emerging data have shown that PPIs could reduce esophageal eosinophilia through novel mechanisms, including suppression of the Th2 cytokine-induced eotaxin-3 expression in esophageal epithelium, as well as improving esophageal epithelial barrier function and other homeostatic pathways [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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

Thakkar

Philpott

LaFata

et al. 2023

JGLD

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Background and Aims: Some eosinophilic esophagitis (EoE) patients can have a decline in eosinophil count after proton pump inhibitor (PPI) treatment without achieving histologic response, but little is known about this group. We aimed to determine the effect of PPIs on reducing esophageal eosinophilia in patients deemed non-responsive to PPI therapy. Methods: We analyzed prospectively collected cohort data from newly diagnosed adults with EoE who were histologic non-responders (≥15 eos/hpf) to PPI-only therapy. Symptoms, endoscopic histologic features were assessed before and after PPI. Pre- and post-PPI treatment esophageal biopsies were read by pathologists to determine peak eosinophil counts and other histologic findings. Results: Of 125 patients, peak eosinophil counts were 102.1 ± 69.8 and 102.9 ± 101.1 (p=0.93) before and after PPI treatment, respectively, but lamina propria fibrosis decreased from 97% to 41% (p<0.001). Heartburn frequency also decreased (19% to 11%; p=0.006), though endoscopic findings did not change. There were 75 patients (60%) who had some decrease in eosinophil counts, with 30 patients (24%) having ≥50% decrease in counts. When comparing the ≥50% and <50% decrease groups, differences in endoscopic features were identified, but the ≥50% group had improvement in eosinophil degranulation, microabscesses, spongiosis, and basal cell hyperplasia. Conclusion: Peak eosinophil counts did not decrease overall after PPI treatment, but symptoms of heartburn improved. Approximately a quarter had ≥50% decrease in eosinophil counts, with associated decreases in other histologic findings. Further research may consider what role PPIs have in this subset of non-responders or in combination therapies.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

Thakkar

Philpott

LaFata

et al. 2023

JGLD

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“…Data of the EoE Connect Registry also showed that patients, mainly adults with inflammatory rather than fibrostenotic phenotypes are more likely to achieve clinico-histological remission after PPI therapy (17). The need for dilation at the time of baseline endoscopy has been correlated with a lower possibility of sustained histological remission with long-term PPI therapy (18). This finding suggests that PPI therapy is less effective in reversing esophageal remodeling associated with EoE.…”

Section: Discussionmentioning

confidence: 99%

“…In the large, prospective EOS Connect Registry, ongoing clinico-histological remission was observed in 69% of 103 patients treated with a lower dose for at least 6 months (17). A recent retrospective study including 50 adults with PPI-responsive EoE indicated that 60% had sustained histological remission for more than 3 years; however, more than 50% were administered the same induction dose (18).…”

Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitor Therapy in Pediatric Eosinophilic Esophagitis: Predictive Factors and Long-Term Step-Down Efficacy

Gutiérrez-Junquera¹,

Fernández‐Fernández²,

Domínguez-Ortega³

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: To assess the short-and long-term efficacy of proton pump inhibitor (PPI) therapy for pediatric eosinophilic esophagitis (EoE) in realworld practice with a step-down strategy, and to evaluate factors predictive of PPI responsiveness. Methods: We collected data regarding the efficacy of PPIs during this crosssectional analysis of the prospective nationwide RENESE registry. Children with EoE treated with PPI monotherapy were included. Histological remission was defined as a peak eosinophilic count of <15 eosinophils (eos)/ high-power field (hpf). Factors associated with PPI responsiveness were identified using multivariate logistic regression analysis. Results: After induction therapy, histological and clinico-histological remission were observed in 51.4% (n = 346) and 46.5% of children, respectively. Normal endoscopic appearance of the esophagus was associated with a higher possibility [odds ratio (OR), 9.20; 95% confidence interval (CI), 2.10-40.16], and fibrostenotic phenotype was associated with a lower possibility (OR, 0.36; 95% CI, 0.18-0.74) of histological remission. Long-term therapy with a step-down strategy effectively maintained histological remission in 68.5% and 85.3% of children at 7 months (n = 108) and 16 months (n = 34), respectively. Complete initial histological remission (≤5 eos/hpf) was associated with a higher possibility of sustained histological remission (OR, 5.08; 95% CI, 1.75-14.68). Adverse events were infrequent and mild. Conclusions: We confirmed the efficacy of PPIs for a large cohort of children with EoE with sustained histological remission using a stepdown strategy. Children with fibrostenotic phenotypes are less likely to respond to induction therapy. Furthermore, patients with complete initial histological remission are more likely to experience long-term histological remission.

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“…Una vez documentada la remisión de la enfermedad con IBP, diversos estudios han evaluado diferentes esquemas de mantenimiento con resultados de eficacia similares. [15][16][17][18][19] Las dosis de IBP y duración, así como la eficacia histológica en estos estudios, se encuentran detalladas en Tabla 1. Resultados de eficacia de los IBP como tratamiento de mantenimiento, con información sobre dosis de mantenimiento y duración de los estudios la Tabla 1.…”

Section: Mantenimientounclassified

Novedades terapéuticas en la esofagitis eosinofílica

Molina–Infante

Lucendo

2022

ACTA

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La esofagitis eosinofílica (EoE) es una enfermedad inmunoalérgica crónica causada, en la mayoría de los casos, por una alergia alimentaria no IgE mediada. Su prevalencia actual es superior a 1 caso por cada 1000 habitantes en España y Europa, mientras que es emergente en el continente sudamericano. Esta revisión trata de actualizar las novedades terapéuticas aparecidas en los últimos 5 años para inducción y mantenimiento en esta patología, incluyendo la aparición de nuevos fármacos antiácidos (inhibidores del ácido competitivos del potasio), la simplificación de los esquemas dietéticos, la aparición de nuevos corticoides deglutidos diseñados específicamente para el tratamiento tópico, así como la incorporación de fármacos biológicos al algoritmo terapéutico de la enfermedad. La dilatación endoscópica continúa siendo un complemento eficaz y seguro para la mejoría sintomática, en combinación con tratamientos antiinflamatorios de la enfermedad.

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Long-term efficacy of proton pump inhibitors as a treatment modality for eosinophilic esophagitis

Cited by 12 publications

References 45 publications

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

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

Proton Pump Inhibitor Therapy in Pediatric Eosinophilic Esophagitis: Predictive Factors and Long-Term Step-Down Efficacy

Novedades terapéuticas en la esofagitis eosinofílica

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