Proton Pump Inhibitor Therapy in Eosinophilic Esophagitis: Predictors of Nonresponse

Alexander, Ryan; Alexander, Jeffrey A.; Akambase, Joseph; Harmsen, William S.; Geno, Debra M.; Tholen, Crystal; Katzka, David A.; Ravi, Karthik

doi:10.1007/s10620-020-06633-4

Cited by 22 publications

(24 citation statements)

References 28 publications

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“…Currently, PPIs are considered one of several first-line treatment options in EoE alongside topical steroids (TCS) and elimination diets (10,11). Studies have attempted to identify phenotypic characteristics that can reliably predict differential responses to PPIs, since these drugs are particularly appealing due to their broad accessibility, good safety profile, and relatively low cost (12)(13)(14). However, despite the increasing incidence of childhood EoE (15), few pediatric data on phenotypic aspects of this condition are available, mostly from North American cohorts (16,17), whereas only a single retrospective series have been reported from Europe (18).…”

Section: What Is Newmentioning

confidence: 99%

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN

Oliva

Dias

Rea

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Few pediatric data on phenotypic aspects of eosinophilic esophagitis (EoE) are available. The pEEr registry was developed to prospectively characterize children with EoE from Europe and Israel. Methods: pEEr is an ongoing prospective registry enrolling children with esophageal eosinophilia (≥15 eos/HPF). Anonymized data were collected from 19 pediatric centers. Data regarding demographics, clinical manifestations, endoscopy, histology, and therapies were collected. Results: A total of 582 subjects (61% male) were analyzed. The median age at diagnosis was 10.5 years [interquartile range (IQR): 5.7-17.7], whereas the age at symptom onset was 9.2 years (IQR: 4.3-16.4), resulting in a median diagnostic delay of 1.2 years (IQR: 0.7-2.3). The diagnostic delay was longer below age <6 years. Shorter diagnostic delays were associated with the presence of food allergy or a family history for EoE. Symptoms varied by age with dysphagia and food impaction more common in adolescents, while vomiting and failure to thrive more common in younger children (P < 0.001). Among endoscopic findings, esophageal rings were more common in adolescents, whereas exudates were more frequent in younger children(P < 0.001). Patients who responded to proton pump inhibitors (PPIs) were more likely to be older, males, and less often presented severe endoscopic findings. Patients unresponsive to PPIs received topical steroids (40%), elimination diet (41%), or a combined therapy (19%). Conclusions: EoE findings vary according to age in pediatric EoE. Young children are commonly characterized by non-specific symptoms, atopic dermatitis, food allergy, and inflammatory endoscopic lesions. Adolescents usually have dysphagia or food impaction, fibrostenotic lesions, and a better PPI response.

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Section: What Is Newmentioning

confidence: 99%

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN

Oliva

Dias

Rea

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…[37][38][39] Predictors of non-response to PPI therapy in patients with EoE were reported to be young age, reduced body mass index (BMI), elevated peripheral eosinophil count, and likely failure of passage of the endoscope from the esophagus to the stomach. 40 Kon et al 41 classified esophageal eosinophilia (EE) into the diffuse type and localized type and described their clinical features.…”

Section: Clinical Features Of Ppi Respondersmentioning

confidence: 99%

The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract)

Nagahara

Shiotani

Iijima

et al. 2021

Digestive Endoscopy

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The Japan Gastroenterological Endoscopy Society held four serial symposia between 2019 and 2020 on the state-of-the-art of issues related to upper GI inflammatory diseases. This review discusses some of the topics addressed in these symposia. The papers regarding nonerosive reflux disease, recent improvements in intraesophageal pH-impedance monitoring and endoscopic diagnosis using image-enhanced endoscopy have been published. Many publications have addressed its usefulness in endoscopic treatment of gastroesophageal reflux disease such as anti-reflux mucosectomy. In the management of eosinophilic esophagitis, since the symptoms are subjective, objective indicators have been sought, and ultrasonography and highresolution manometry may be useful tools for evaluation. The natural course of this condition, especially of asymptomatic cases, is not well clarified. Some newly developed anti-acid or anti-inflammatory medicines are now under investigation. With regard to autoimmune gastritis, because of widespread medical examinations, diagnosis of asymptomatic cases has been increasing. Recently, its endoscopic characteristics have become clear and the natural history of these conditions is being elucidated. The Kyoto Classification of Gastritis has been reported to be useful not only for Helicobacter pylori diagnosis but also for identification of risks of gastric cancer. Its usefulness is now recognized in Asia and Europe.

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“…A few studies have assessed the role of body weight and BMI in children and adolescents with EoE, and no articles were published on EGIDs distal to the esophagus ( Table 2 ). There is evidence that most adults with EoE mainly have a good nutritional status and expected BMI values [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Despite feeding or swallowing issues, EoE children did not generally report nutritional deficiency or impaired growth [ 23 ].…”

Section: Obese and Overweight Egid Patientsmentioning

confidence: 99%

Malnutrition in Eosinophilic Gastrointestinal Disorders

et al. 2020

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Primary eosinophilic gastrointestinal disorders (EGIDs) are emerging chronic/remittent inflammatory diseases of unknown etiology, which may involve any part of the gastrointestinal (GI) tract, in the absence of secondary causes of GI eosinophilia. Eosinophilic esophagitis is the prototype of eosinophilic gastrointestinal disorders and is clinically characterized by symptoms related to esophageal inflammation and dysfunction. A few studies have assessed the nutritional status of patients with eosinophilic gastrointestinal disorders, showing conflicting results. This review summarizes the current evidence on the nutritional status of patients with EGIDs, focusing on the pediatric point of view and also speculating potential etiological mechanisms.

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Proton Pump Inhibitor Therapy in Eosinophilic Esophagitis: Predictors of Nonresponse

Cited by 22 publications

References 28 publications

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN

The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract)

Malnutrition in Eosinophilic Gastrointestinal Disorders

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