Introduction

One possible treatment option for Eosinophilic Esophagitis (EoE) is Protone Pump Inhibitor (PPI) therapy. The possible mechanisms of action discussed include acid suppression and a direct anti-inflammatory effect. However, only up to 50% of EoE patients respond to PPI therapy. Predicting the therapeutic response is challenging, so the aim of this study was to identify potential predictors for a response to such therapy.

Aims & Methods

Patients with active EoE (defined as the presence of esophageal symptoms and simultaneous detection of >15 eosinophilic granulocytes per high-power field [HPF] in at least one biopsy from the esophagus) were retrospectively identified from the hospital database of a tertiary university referral center over 5 years. These patients had received sufficient PPI therapy (defined as double standard dose for at least four weeks). The analysis focused on their therapeutic response and potential predictors including clinical, histological and functional parameters of treatment success.

Results

151 EoE patients were screened and of them 57 patients (mean age: 41 years; 81% male; mean maximum eosinophil count: 55/HPF) who had received PPI therapy at double standard dose for at least 4 weeks (mean duration: 62 days) were finally included. Histopathological complete remission (defined as <5 eosinophils/HPF) was achieved in 18 of 57 patients (31.6%) following PPI treatment, while partial remission (defined as <15 eosinophils/HPF) was observed in 25 of 57 patients (43.9%). No response to PPI therapy was noted in 14 of 57 patients (24.6%). There were no significant differences of the assessed predictors in EoE patients with and without PPI response, although patients with PPI response showed a distally emphasized esophageal eosinophilia and a higher acid exposure time in pH-metry (both non-significant).

Conclusion

No definitive predictors for the response to PPI therapy in EoE patients could be identified. However, a distally predominant esophageal eosinophilia and higher acid exposure time in patients responding to PPI therapy may suggest a contributory role of gastroesophageal reflux in this cohort.

References

No definitive predictors for the response to PPI therapy in EoE patients could be identified. However, a distally predominant esophageal eosinophilia and higher acid exposure time in patients responding to PPI therapy may suggest a contributory role of gastroesophageal reflux in this cohort.