EoE Module 10 References-Eluri et al Curr Opin Gastroenterol 2015 Proton pump inhibitor-responsive oesophageal eosinophilia and EoE More similarities than differences

Eluri et al Curr Opin Gastroenterol 2015 Proton pump inhibitor-responsive oesophageal eosinophilia and EoE More similarities than differences

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The article by Swathi Eluri and Evan S. Dellon explores the relationship between Proton Pump Inhibitor-Responsive Esophageal Eosinophilia (PPI-REE) and Eosinophilic Esophagitis (EoE), focusing on their clinical, endoscopic, and histologic similarities and differences. PPI-REE is characterized by esophageal symptoms similar to EoE but resolves with PPI treatment. Both conditions exhibit elevated Th2-related inflammatory markers like IL-13, IL-5, and eotaxin-3, indicating a shared pathogenesis. <br /><br />Research suggests that over one-third of patients with esophageal eosinophilia respond to PPI therapy, raising questions about the nature of PPI-REE as either a subtype of EoE or a distinct condition. The overlap of symptoms, demographics, and histologic features complicates differentiation between PPI-REE and EoE, and whether GERD plays a role in PPI-REE remains unsolved. The presence of genetic expression signatures in PPI-REE aligning with EoE reinforces the idea of a possible shared immune-mediated pathogenesis.<br /><br />Investigations into the pathogenesis of PPI-REE include the acid-independent, anti-inflammatory actions of PPIs, potentially restoring esophageal barrier function. Additionally, PPIs may directly inhibit the expression of eotaxin-3, a key mediator in EoE and PPI-REE pathogenesis. The article suggests that PPI-REE might be redefined as a subtype of EoE, which could impact future treatment algorithms, potentially elevating PPIs to first-line therapy for EoE.<br /><br />Overall, the article identifies a diagnostic challenge in distinguishing between EoE and PPI-REE due to their significant overlap and presents a case for further studies into their relationship, particularly focusing on genetic and inflammatory markers as potential diagnostic tools. The article concludes that future revisions in the diagnosis and management of esophageal eosinophilia are likely.

Keywords

PPI-REE

Eosinophilic Esophagitis

Proton Pump Inhibitors

esophageal eosinophilia

Th2 inflammation

IL-13

IL-5

eotaxin-3

GERD

esophageal barrier function