Effect of Proton Pump Inhibitor on Esophageal Eosinophilia

Objective: Differentiation between the common etiologies of dense esophageal eosinophilia such as gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can be difficult. We hypothesized that histologic features may provide diagnostic clues concerning the etiology of esophageal eosinophilia. Methods: We performed a retrospective chart review of 204 children with the diagnosis of esophagitis characterized by ≥15 eosinophils (eos) per high-power field (HPF) in at least 1 biopsy. We then restricted our analysis to subjects who had received at least 8 weeks of only proton pump inhibitors (PPIs) followed by endoscopy and who had a clinicopathologic response to this treatment. Symptoms, endoscopic findings, and pathologic descriptions were reviewed and an eosinophil peroxidase (EPX) index was determined to assess for degranulation/eosinophil activation. Results: Of the 204 identified charts, 7 subjects identified met the inclusion criteria. Five of these 7 patients showed a clinicopathologic response to PPIs after their follow-up endoscopy, (mean peak eosinophil count: 92 vs 5 eos/HPF, and EPX index: 39.2 vs 14.6, pre- and posttreatment, respectively). Two patients experienced initial resolution of symptoms and esophageal eosinophilia with PPI therapy; however, within 17–23 months they redeveloped symptoms and esophageal eosinophilia while receiving PPI therapy at the time of a third endoscopy (mean peak eosinophil count: 40 vs 11 vs 36 eos/HPF, and EPX index: 44 vs 21 vs 36.5, pre-, post- and posttreatment, respectively). No clinicopathologic features or degranulation patterns differentiated subjects with GERD/PPI responsive esophageal eosinophilia from those who had transient response to PPI treatment. Conclusions: No clinicopathologic features differentiated subjects who responded to PPI treatment. PPI treatment can be helpful to exclude GERD and PPI responsive esophageal eosinophilia but long-term follow-up is critical in the management of esophagitis.

[1]  T. Smyrk,et al.  Increased numbers of eosinophils, rather than only etiology, predict histologic changes in patients with esophageal eosinophilia. , 2012, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[2]  S. Spechler,et al.  Omeprazole blocks eotaxin-3 expression by oesophageal squamous cells from patients with eosinophilic oesophagitis and GORD , 2012, Gut.

[3]  E. Gelfand,et al.  Successful treatment of eosinophilic esophagitis with ciclesonide. , 2012, The Journal of allergy and clinical immunology.

[4]  S. Aceves,et al.  Transient PPI Responsive Esophageal Eosinophilia May Be a Clinical Sub-phenotype of Pediatric Eosinophilic Esophagitis , 2012, Digestive Diseases and Sciences.

[5]  A. Schoepfer,et al.  Eosinophilic esophagitis: updated consensus recommendations for children and adults. , 2011, The Journal of allergy and clinical immunology.

[6]  C. Ripoll,et al.  Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults. , 2011, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[7]  T. Smyrk,et al.  Marked Deposition of Eosinophil-Derived Neurotoxin in Adult Patients With Eosinophilic Esophagitis , 2010, The American Journal of Gastroenterology.

[8]  S. Aceves,et al.  A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation. , 2009, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[9]  J. James.  Predictors of Response to Proton Pump Inhibitor Therapy Among Children With Significant Esophageal Eosinophilia , 2009, Pediatrics.

[10]  S. Baker,et al.  Treatment With High-dose Proton Pump Inhibitors Helps Distinguish Eosinophilic Esophagitis From Noneosinophilic Esophagitis , 2009, Journal of pediatric gastroenterology and nutrition.

[11]  S. Spechler,et al.  Potential Anti-inflammatory Effects of Proton Pump Inhibitors: A Review and Discussion of the Clinical Implications , 2009, Digestive Diseases and Sciences.

[12]  A. Straumann,et al.  What's new in the diagnosis and therapy of eosinophilic esophagitis? , 2009, Current opinion in gastroenterology.

[13]  V. Sharma,et al.  A novel histologic scoring system to evaluate mucosal biopsies from patients with eosinophilic esophagitis. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[14]  M. Lovell,et al.  Eosinophilic esophagitis: the newest esophageal inflammatory disease , 2009, Nature Reviews Gastroenterology &Hepatology.

[15]  M. Stolte,et al.  Comparison of histological parameters for the diagnosis of eosinophilic oesophagitis versus gastro‐oesophageal reflux disease on oesophageal biopsy material , 2008, Histopathology.

[16]  J. Demain,et al.  Food allergy and eosinophilic gastrointestinal disorders: guiding our diagnosis and treatment. , 2008, Current problems in pediatric and adolescent health care.

[17]  A. Schoepfer,et al.  Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[18]  D. Katzka,et al.  Atopic characteristics of adult patients with eosinophilic esophagitis. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[19]  A. Berghaus,et al.  [Eosinophilic esophagitis : a cause of dysphagia]. , 2008, HNO.

[20]  M. Kramer,et al.  Die eosinophile Ösophagitis , 2008, HNO.

[21]  S. Aceves,et al.  Oral Viscous Budesonide: A Potential New Therapy for Eosinophilic Esophagitis in Children , 2007, The American Journal of Gastroenterology.

[22]  A. Straumann,et al.  Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. , 2007, Gastroenterology.

[23]  S. Spechler,et al.  Thoughts on the Complex Relationship Between Gastroesophageal Reflux Disease and Eosinophilic Esophagitis , 2007, The American Journal of Gastroenterology.

[24]  S. Aceves,et al.  Distinguishing Eosinophilic Esophagitis in Pediatric Patients: Clinical, Endoscopic, and Histologic Features of An Emerging Disorder , 2007, Journal of clinical gastroenterology.

[25]  D. Antonioli,et al.  Eosinophils in the Esophagus—Peptic or Allergic Eosinophilic Esophagitis? Case Series of Three Patients with Esophageal Eosinophilia , 2006, The American Journal of Gastroenterology.

[26]  K. Badizadegan,et al.  Association of eosinophilic inflammation with esophageal food impaction in adults. , 2005, Gastrointestinal endoscopy.

[27]  T. Sentongo,et al.  Adherent white plaques: an endoscopic finding in eosinophilic esophagitis. , 2004, Journal of pediatric gastroenterology and nutrition.

[28]  K. Badizadegan,et al.  Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. , 2002, Gastroenterology.

[29]  H. Goldman,et al.  Intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis. , 1982, Gastroenterology.

[30]  M. Collins,et al.  Histopathologic features of eosinophilic esophagitis. , 2008, Gastrointestinal endoscopy clinics of North America.

[31]  V. Fox.  Eosinophilic esophagitis: endoscopic findings. , 2008, Gastrointestinal endoscopy clinics of North America.