The Predictive Factors of Responsiveness to Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis

Approximately half of patients with eosinophilic esophagitis (EoE) respond clinically and histologically to proton pump inhibitor (PPI) therapy. Although recent guidelines suggest that PPI-responders and non-responders were included in EoE, it is important to investigate the predictive factors of PPI- responsiveness. This study aimed to determine the rate of PPI- responders and compare the characteristics of PPI-responders and non-responders. Fifty-nine patients with esophageal eosinophilia received PPI therapy for eight weeks, and its efficacy was assessed. PPI- responsiveness was diagnosed based on the relief in symptoms and reduction of intraepithelial eosinophilic infiltration to <15 per high-power field (hpf) after PPI therapy. Multivariate analysis was performed to identify factors associated with PPI-responders. Of the 59 patients, 41 (69.5%) were diagnosed with PPI-responders. The rate of gastrointestinal (GI) screening in the indications for endoscopy was significantly higher in patients with PPI- responders than in those with non-responders. On multivariate analysis, GI screening and presence of reflux esophagitis was associated with an increased odds ratio (OR) of PPI-responders, but presence of rings with a decreased OR of PPI-responders. Presence of reflux esophagitis and absence of rings on endoscopy especially during GI screening might be significant predictive factors for PPI response in patients with EoE.

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Empiric proton pump inhibitor therapy after esophageal food impaction may mask eosinophilic esophagitis diagnosis at follow-up

Diseases of the Esophagus ◽

10.1093/dote/doab030 ◽

2021 ◽

Author(s):

Luke Hillman ◽

Sarah Donohue ◽

Aimee Teo Broman ◽

Patrick Hoversten ◽

Eric Gaumnitz ◽

...

Keyword(s):

Proton Pump Inhibitor ◽

Proton Pump ◽

Eosinophilic Esophagitis ◽

Empiric Therapy ◽

Proton Pump Inhibitor Therapy ◽

Significant Heterogeneity ◽

Food Impaction ◽

Esophageal Food Impaction ◽

The Impact

Summary Esophageal food impaction (EFI) is often the first presentation for patients with eosinophilic esophagitis (EoE); however, there is significant heterogeneity in the management of EFI. We aimed to study the impact of EFI management, particularly post-EFI medication prescriptions on EoE diagnosis, follow-up, and recurrence in patients with endoscopic features of EoE. In our retrospective study, adults presenting between 2007 and 2017 with EFI requiring endoscopic dis-impaction with endoscopic features of EoE (furrows, rings, and/or exudates) were included. We examined the impact of demographics and EFI management on EoE diagnosis, follow-up (esophagogastroduodenoscopy [EGD] or clinic visit within 6 months), and recurrence. We identified 164 cases of EFI due to suspected EoE. Biopsy was performed in 68 patients (41.5%), and 144 patients (87.8%) were placed on proton pump inhibitor (PPI) and/or swallow corticosteroids after EFI, including 88.5% of those not biopsied. PPI use at time of biopsy was negatively associated with EoE diagnosis (odds ratio: 0.39, confidence interval: 0.17–0.85). Sixty-one (37.4%) patients were lost to follow-up at 6 months. Recurrent EFI at 1 year occurred in 3.7% of patients. Medications, most commonly PPI, are frequently prescribed after EFI when the endoscopic features of EoE are present, which may mask the diagnosis of EoE on follow-up EGD. We estimated that for every five patients biopsied on PPI, one case of EoE is masked. As recurrent EFI within 1 year is uncommon, empiric therapy should be avoided until diagnostic biopsies are obtained. Further efforts to reduce loss to follow-up after EFI are also needed.

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