142. EFFECTS OF PPIS AND P-CAB ON RESPONSES ACCORDING TO OUTCOMES OF SYMPTOM, ENDOSCOPY, AND HISTOLOGY IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Abstract

Abstract Background and Aim Acid-suppressive drugs such as proton pump inhibitors and potassium-competitive acid blockers (PPIs/P-CABs) are often used to treat eosinophilic esophagitis (EoE). Treatment response is based on outcomes including, symptoms, endoscopy, and histology; however, the detailed response rate to PPI/P-CAB is unknown. We aimed to examine the response rate to PPIs/P-CABs and prevalence of topical corticosteroid (TCS) therapy as the second-line treatment for EoE, and compare efficacy between PPIs and P-CAB. Methods In total, 236 patients with histologically confirmed EoE who received PPI/P-CAB as the first-line treatment were included. We assessed the symptoms, endoscopic reference score (EREFS), and histology (eosinophils per high-power field, eos/hpf) 8 weeks after PPI/P-CAB administration. Complete normalization was defined as disappearance of symptoms, EREFS score 0, or 0–1 eos/hpf and response as disappearance or improvement of symptoms, EREFS score ≤ 2, or < 15 eos/hpf. The prevalence of TCS therapy in each response group was assessed. Results Complete normalization of PPI/P-CAB was achieved in 25%, 50%, 36%, and 8% of patients for symptoms, endoscopy, histology, and all three outcomes, respectively. The response rates of PPI/P-CAB were 81%, 87%, 87%, 75%, and 60% for symptoms, endoscopy, histology, and all three outcomes, respectively. There were no significant differences in compete normalization and response rate of any outcomes between PPIs and P-CAB. TCS use was significantly lower (8%) in patients who achieved response of all three outcomes than in other groups, and was dependent on the number of outcomes with non-response. Conclusions Complete normalization of symptoms, endoscopy, and histology using PPI/P-CAB is uncommon. Based on treatment efficacy by response/non-response, TCS was the secondary treatment in cases with an increase in the number of non-response outcomes. Treatment efficacy of PPIs and P-CAB was similar.