EoE Module 10 References-Molina-Infante et al Gut 2017 PPI-REE Task Force of the EUREOS Clarifying misunderstandings and misinterpretations about PPI-responsive EoE

Molina-Infante et al Gut 2017 PPI-REE Task Force of the EUREOS Clarifying misunderstandings and misinterpretations about PPI-responsive EoE

Back to course

Pdf Summary

The article by Molina-Infante et al. addresses misunderstandings related to proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), particularly in the context of differentiating it from eosinophilic esophagitis (EoE) and gastro-oesophageal reflux disease (GORD). The response was prompted by concerns from a separate letter by Muir et al., which raised diagnostic challenges in pediatric patients.<br /><br />The authors state that for adults showing dysphagia, a key symptom, an endoscopy should be performed to check eosinophilia, ensuring accurate diagnosis and avoiding unnecessary procedures. In children, morerandom symptoms like feeding difficulties and abdominal pain make the diagnosis more complex. The choice between PPI therapy and endoscopy should be individualized based on each case, urging further study to establish optimal strategies.<br /><br />Molina-Infante et al. underscore that symptom resolution with PPIs, alone, should not dictate diagnosis since symptoms overlap in conditions like GORD, PPI-REE, and EoE. They stress the necessity of endoscopic examination with biopsies for precise diagnosis.<br /><br />The paper argues against the notion of interchangeability between PPI-REE and EoE, acknowledging their overlapping clinical and molecular features. Although the genetic expression profile of the disorders is strikingly similar, disconnecting them based on treatment response is not justifiable. The authors address concerns about medication levels used in studies, establishing that certain effects were observed with conventional omeprazole doses.<br /><br />They acknowledge the unresolved question of whether inflammation in PPI-REE is due to acid reflux or antigen exposure, agreeing that GORD and EoE can coexist, with the potential of one exacerbating the other. The authors advocate for continued research to improve diagnosis and treatment approaches for PPI-REE, especially in pediatric cases. Lastly, they call for the findings of Muir et al.'s patient series to be subjected to peer review for a scientific debate based on high-quality evidence.

Keywords

PPI-REE

eosinophilic esophagitis

GORD

dysphagia

endoscopy

pediatric diagnosis

proton pump inhibitors

biopsies

acid reflux

antigen exposure