Abstract
To the Editor: In a recent issue of the American Journal of Gastroenterology, we read with immense interest the article by Merwat and Spechler (1) about the possible role of acid-suppressive medications in the pathogenesis of eosinophilic esophagitis. At present, the etiology of eosinophilic esophagitis is still questionable. What is already known is that eosinophilic esophagitis is a manifestation of food allergy and that personal or family history of atopy represents a predisposing factor. The authors discuss the possible role of acid-suppressive therapy in the pathogenesis of eosinophilic esophagitis by two probable mechanisms: insufficient protein degradation due to proteinase inactivity in diminished gastric acidity, which can elicit an immune response, and increased mucosal permeability as a consequence of therapy with proton pump inhibitors, which can contribute to the development of food allergy (2,3,4).
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