Response to Proton Pump Inhibitor Therapy in a Racially Diverse Cohort of Pediatric Eosinophilic Esophagitis

Abstract

Introduction: Eosinophilic Esophagitis (EoE) is a chronic immunologic disorder characterized by esophageal dysfunction and dense esophageal eosinophilia. The incidence rates are 5.1 and 7 per 100,000 person years in children and adults respectively, and is described to affect a predominantly caucasian population. An initial histologic response to Proton Pump Inhibitor has long been viewed as favoring Gastroesophageal reflux disease and its use is thus proposed in the diagnostic approach. It is evident from recent literature that PPI therapy has an anti-eosinophil effect, thereby inducing a histologic response independent of GERD status. We investigated the response to the initial PPI regimen in a uniquely diverse cohort of children with EoE. Methods: We performed a retrospective review of data pertaining to children referred to the multidisciplinary EoE clinic at Children's National Medical Center (CNMC). We included children with EoE (peak >15 eos/hpf at any esophageal level) who underwent a histologic reassessment after 8 weeks of PPI (1-3 mg/kg/day) at CNMC. Histologic response was defined as 5-15 eos/hpf and remission as <5 eos/hpf. Results: We reviewed data for 71 children with EoE, age 8 mo-17 yr (6 yr), Caucasian 26 (36.6%), and 43% African Americans (AA) among non-Caucasians. Only 15 children met inclusion criteria comprising of 73% males, 53% non-Caucasians including 33% AA, age range 1-17 yr (7.6 yr). Histologic remission with minimal symptomatic improvement occurred in only 1 patient. The pre-PPI and post-PPI therapy peak eos/hpf were 10-100 (52) and 1-100 (54), p = 0.74). Conclusion: We did not observe PPI therapy as sufficient to alter esophageal histologic status favorably in contrast to adults with EoE. To our knowledge, our Pediatric EoE, is the only uniquely non Caucasian predominant cohort reported to date. The retrospective nature, variable regimens, and absence of formal GERD investigations are limitations of the study. Extending the analysis to additional patients is expected to provide useful insight into PPI effects in EoE.