Proton Pump Inhibitors Partially Restore Mucosal Integrity in Patients With Proton Pump Inhibitor–Responsive Esophageal Eosinophilia but Not Eosinophilic Esophagitis

Eosinophilic Esophagitis- Clinical Management in Adults

“…To exclude PPI-REE, patients with suspected EoE, a high dose PPI trial (20-40 mg twice daily of any of the available agents for 8 weeks) should be given followed by endoscopy with biopsies. Several studies reported response to PPIs treatment in up to 2/3 (75%) of cases as there is a speculation that PPIs may have anti-inflammatory or barrier-healing properties that contribute to resolution of esophageal eosinophilia [50,51]. If a patient responds to this regimen (clinical, endoscopic, and/or histologic response), then additional clinical evaluation should be performed to determine if GERD was the cause of the esophageal eosinophilia.…”

Diagnosis and treatment of eosinophilic esophagitis in clinical practice

“…In the consensus recommendation for EoE in 2011, it was proposed that those conditions should be discriminated from EoE as a new potential disease entity termed ''PPI-REE.'' Although the underlying mechanism of PPI-REE remains unclear, two theories have been mainly proposed: (1) PPI blocks the permeation of the causal allergens from the esophageal luminal surface to the subepithelium by curing the acidic damage (e.g., dilated intracellular space or erosions in the esophageal epithelium); [68,117,118] and (2) PPI potentially reduces eosinophilic inflammation by suppressing Th2-associated cytokine or gene expression as topical steroids, independently of the gastric acid inhibitory effect [119,120]. Thus, symptomatic and histological resolution of EE by PPI does not necessarily indicate the existence of GERD as a potential cause of EE [121].…”

Editorial: is eosinophilic oesophagitis different to proton pump inhibitor‐responsive oesophageal eosinophilia?

“…However, their conclusion is limited by the fact that these data were not evaluated in PPI-REE patients after PPI therapy. Indeed, mucosal integrity restoration and anti-allergic effects, similar to those exerted by topical steroids in EoE, have been recently reported in PPI-REE after PPI therapy [6][7][8] (Table 1). AP&T invited editorial columns are restricted to discussing papers that have been published in the journal.…”

“…Therefore, PPI-REE might have a similar pathogenesis to that of EoE, but the role of epithelial barrier dysfunction 4,5 caused by acid reflux, or the responsiveness to any antiinflammatory effects of PPI 6,7 might be different between the two diseases.…”

“…Basophil and mast cell epithelial infiltration was significantly higher in both groups, but not in gastrooesophageal reflux (GERD) patients or control subjects. Several recent studies [2][3][4][5][6][7][8] have failed to find distinguishing features between EoE and PPI-REE (Table 1). The study by Iwakura et al 1 aligns with the evolving concept that both entities share the same pathogenesis.…”