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

Atsushi Hashimoto,Noriko Kamata,Narika Iwakura,Yasuhiro Fujiwara,Risa Uemura,Akinari Sawada,Koji Otani,Tetsuya Tanigawa,Hirokazu Yamagami,Fumio Tanaka,Toshio Watanabe,Yasuaki Nagami,Takashi Sugawa,Shuhei Hosomi,Koichi Taira

doi:10.3390/gidisord1010017

Atsushi Hashimoto, Noriko Kamata + Show 13 more

Open Access

https://doi.org/10.3390/gidisord1010017

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Journal: Gastrointestinal Disorders	Publication Date: Feb 25, 2019
Citations: 1	License type: CC BY 4.0

Affiliation: Osaka City University

Abstract

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.

Highlights

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease that might occur due to exposure to food and/or aeroallergens [1,2]
Approximately 70% of patients with EoE responded to pump inhibitor (PPI) therapy
Multivariate analysis identified endoscopy for screening, reflux esophagitis, and the absence of rings as factors significantly associated with PPI-responders

Summary

Introduction

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease that might occur due to exposure to food and/or aeroallergens [1,2]. EoE is defined as presence of esophageal symptoms such as dysphagia and food impaction, as well as intraepithelial eosinophil infiltration of ≥15 per high power field (hpf) on esophageal mucosal biopsies, and is usually diagnosed based on the typical endoscopic findings [3]. Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a defined entity that has clinical symptoms and histological findings similar to those of EoE but responds positively to PPI therapy in terms of clinical and histological outcomes [8]. 2019, 1 FOR PEER REVIEW gugidueildineleinaendancdoncosennsseunssusus gsuggesgteesdtetdhatthPatPPI-PRIE-REEbEebinecilnucdlueddeidn iEnoEEo[E10[,1101,]1.1S]e. VSeervaelrsatlusdtuiedsiaens aalnyazleydzed difdfeifrfeenrceenscebsetbweteweneePnPPI-PreI-srpeosnpdoenrdser(Ps P(PI-PRIE-RE)EEa)ndanndonn-orne-srpeosnpdoenrdse, rbsu, tbumtomstofsatilfeadiletdo tfoinfidnadnyany sigsniigfniciafinctandtifdfeifrfeenrecensce[1s2[–1125–]1.5] Disord. 2019, 1 FOR PEER REVIEW gugidueildineleinaendancdoncosennsseunssusus gsuggesgteesdtetdhatthPatPPI-PRIE-REEbEebinecilnucdlueddeidn iEnoEEo[E10[,1101,]1.1S]e. vSeervaelrsatlusdtuiedsiaens aalnyazleydzed difdfeifrfeenrceenscebsetbweteweneePnPPI-PreI-srpeosnpdoenrdser(Ps P(PI-PRIE-RE)EEa)ndanndonn-orne-srpeosnpdoenrdse, rbsu, tbumtomstofsatilfeadiletdo tfoinfidnadnyany sigsniigfniciafinctandtifdfeifrfeenrecensce[1s2[–1125–]1.5]

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