S1215 Impact of Medication Compliance on Tissue Response to Proton Pump Inhibitor and Topical Steroid Combination Therapy in Children With Eosinophilic Esophagitis

Abstract

INTRODUCTION: A combination of proton pump inhibitor and topical steroid (PPI/TS) is used to treat eosinophilic esophagitis (EoE). Improper administration of these drugs can result in persistence of eosinophilic inflammation and lead to refractory EoE, esophageal remodeling, and food impaction. As such, strict adherence to these drugs is emphasized in order to achieve histologic remission. However, the relationship between compliance to PPI/TS and tissue response in children with EoE has not been studied. The aims of this study were to determine the association between PPI/TS compliance and both peak eosinophil count/high power field (PEC) and EoE activity, and to identify patient factors associated with 100% compliance to PPI/TS. METHODS: We prospectively collected self-reported compliance (rated between 0% and 100%) to PPI/TS from 37 children (or caregivers) with EoE on the day of their esophagogastroduodenoscopy (EGD). Their demographics (age, gender, ethnicity), clinical information (duration of EoE, presence of symptoms during the week leading up to their EGD), PEC, and EoE activity status (active or inactive based on PEC threshold of 15) were also gathered. The median [interquartile range (IQR)] for continuous variables and percentages for categorical variables were analyzed. RESULTS: The median age of our cohort was 9 (7–12) years, and most were Caucasian (81%). The median self-reported compliance was 100% (90–100%) [range: 50–100%]. PEC negatively correlated with increasing compliance to PPI/TS (Spearman's rho = −0.33; P = 0.04). The median PEC was significantly lower in children with 100% compliance when compared to those with <100% compliance [3 (0–35) vs. 40 (4–73); P = 0.04]. Furthermore, a significantly smaller proportion of children in the 100% compliance group had active EoE when compared to <100% compliance group [10 (38%) vs. 7 (64%); P = 0.01] (Table 1). Patient demographic and clinical factors were not associated with 100% compliance to PPI/TS. CONCLUSION: This is the first study to evaluate the impact of self-reported compliance to PPI/TS in children with EoE. Our results support strict adherence to PPI/TS irrespective of patient’s demographic or clinical factors in order to achieve favorable tissue response. Adequately powered longitudinal studies utilizing objective methods to ascertain compliance to pharmacologic therapy are warranted to better understand the relationship between compliance to pharmacologic therapy and tissue response in EoE.Table 1.: Characteristics of the cohort