EoE ToT Module 4 References-Kia et al Nat rev Gastroenterol Hepatol 2015 Distinguishing GERD from eosinophilic oesophagitis Concepts and controversies

Kia et al Nat rev Gastroenterol Hepatol 2015 Distinguishing GERD from eosinophilic oesophagitis Concepts and controversies

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The document explores the challenge of distinguishing between gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE), particularly focusing on the overlap and mechanisms underlying these conditions. EoE is an immune-mediated disorder characterized by symptoms of esophageal dysfunction and eosinophilic inflammation, while GERD involves inflammatory responses due to acid reflux. Both conditions exhibit similar symptoms such as heartburn, chest pain, and dysphagia, complicating their differentiation.<br /><br />Historically, esophageal eosinophils were seen as markers for GERD. However, with increased understanding, marked eosinophilia has become central to the diagnosis of EoE, tied to immune responses against food or environmental antigens. The emergence of patients showing EoE-like symptoms and histology that resolve with proton pump inhibitors (PPIs) has introduced the concept of PPI-responsive esophageal eosinophilia (PPI-REE). Studies suggest PPI-REE closely resembles EoE clinically and immunologically more than GERD.<br /><br />Key aspects discussed include:<br />1. **Historical Perspective**: Initially, eosinophils in the esophagus were considered indicative of GERD. The distinction of EoE as a separate entity began in the early 1990s.<br />2. **Interactions between EoE and GERD**: There are several proposed interactions, including GERD causing mild eosinophilia, EoE and GERD coexisting independently, and each condition potentially contributing to the other.<br />3. **PPI-REE**: PPIs are effective in reducing eosinophilia in a significant subset of patients suspected of having EoE, raising questions on whether PPI-REE is a subset of EoE, a form of GERD, or a distinct entity.<br />4. **Challenges in Diagnosis**: Using PPI response as a diagnostic criterion for EoE is debated, given the overlap of symptoms and histological findings between these conditions, and limitations in diagnostic tests like pH monitoring.<br /><br />The document ultimately underscores the importance of thoroughly understanding the complex relationship between GERD and EoE for effective management. It concludes that current evidence suggests PPI-REE is closer to EoE rather than GERD, advocating the inclusion of a therapeutic PPI trial in the diagnostic evaluation of suspected EoE due to practical benefits and the safety profile of PPIs.

Keywords

GERD

EoE

PPI-REE

esophageal eosinophils

proton pump inhibitors

esophageal dysfunction

eosinophilic inflammation

heartburn

diagnostic challenges

immune-mediated disorder