EoE Module 10 References-Cheng Curr Opin Gastroenterol 2013 Proton pump inhibitors for eosinophilic oesophagitis

Cheng Curr Opin Gastroenterol 2013 Proton pump inhibitors for eosinophilic oesophagitis

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The article by Edaire Cheng explores the role of proton pump inhibitors (PPIs) in treating eosinophilic esophagitis (EoE), an immune-mediated condition affecting the esophagus with eosinophil-predominant inflammation. Historically, PPIs have been used to distinguish EoE from gastroesophageal reflux disease (GERD) based on their ability to suppress gastric acid. However, recent findings indicate that PPIs may have anti-inflammatory effects independent of acid suppression, as seen in patients with "PPI-responsive esophageal eosinophilia."<br /><br />EoE and GERD share overlapping symptoms and histological features, making it challenging to differentiate them. Traditionally, a response to PPI therapy suggested GERD; however, patients with PPI-responsive esophageal eosinophilia exhibit EoE symptoms and histological improvements without evidence of GERD. Studies have shown that PPIs like omeprazole can inhibit the secretion of eotaxin-3, a key eosinophil chemoattractant, suggesting that PPIs may exert anti-inflammatory actions through mechanisms other than acid suppression. These mechanisms include chromatin remodeling, which reduces transcriptional activity that promotes inflammation.<br /><br />Furthermore, the article highlights that PPIs possess other anti-inflammatory properties, such as antioxidant actions and the inhibition of immune cell functions. Despite these positive effects, PPIs may provide symptomatic relief in EoE without complete histological remission, emphasizing the need for a nuanced approach to diagnosis and treatment.<br /><br />Overall, Cheng recommends a clinical trial of PPI therapy for patients presenting esophageal eosinophilia, irrespective of the initial diagnosis, suggesting that a favorable response to PPIs should not rule out EoE. Further research is needed to fully understand the mechanisms and benefits of PPI-responsive esophageal eosinophilia.

Keywords

proton pump inhibitors

PPIs

eosinophilic esophagitis

EoE

gastroesophageal reflux disease

GERD

anti-inflammatory effects

esophageal eosinophilia

eotaxin-3

chromatin remodeling