EoE Module 10 References-Molina-Infante et al Gut 2016 Proton pump inhibitor-responsive oesophageal eosinophilia An entity challenging current diagnostic criteria for EoE

Molina-Infante et al Gut 2016 Proton pump inhibitor-responsive oesophageal eosinophilia An entity challenging current diagnostic criteria for EoE

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The article discusses the emerging concept of proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), challenging the traditional diagnostic criteria that differentiate gastroesophageal reflux disease (GORD) from eosinophilic esophagitis (EoE). EoE is traditionally understood as an allergen-driven condition with eosinophil buildup in the esophagus, while GORD is due to acid reflux resulting in inflammation. PPI-REE refers to cases where patients exhibit EoE symptoms but respond positively to proton pump inhibitors (PPIs), which were initially seen as mostly effective for acid-related disorders like GORD.<br /><br />Emerging evidence suggests that PPI-REE and EoE share many identical clinical, endoscopic, and histological features, including Th2 immune response markers, and molecular characteristics. The article highlights that PPIs can improve esophageal mucosal integrity and reduce eosinophilic inflammation, mimicking the effects of steroids used in EoE treatment. Surprisingly, even patients previously responsive to dietary or steroidal treatment for EoE may achieve remission with PPI therapy.<br /><br />This evidence casts doubt on the differentiation between PPI-REE and EoE purely based on PPI response, suggesting that both may be part of a continuum rather than distinct entities. The authors propose reconsidering the role of PPIs, viewing them not just as a diagnostic test but as a viable therapeutic option in EoE cases. They suggest PPIs could be considered first-line treatment due to their high response rates and safety profile before other therapies are initiated.<br /><br />The article calls for more research to understand why some EoE patients respond to PPIs while others do not, as well as the potential genetic, environmental, or additional factors influencing these responses. There remains a need to clearly define the overlap and distinctions between EoE and PPI-REE to enhance patient diagnosis and treatment strategies effectively.

Keywords

proton pump inhibitor-responsive esophageal eosinophilia

PPI-REE

eosinophilic esophagitis

EoE

gastroesophageal reflux disease

GORD

proton pump inhibitors

PPIs

esophageal mucosal integrity

Th2 immune response