title: Conservative long-term treatment of children with eosinophilic esophagitis.
abstract: BACKGROUND
  Current treatments of eosinophilic esophagitis (EoE), including restrictive diets or glucocorticoids, provide only transient improvement. Proton pump inhibitor (PPI) use in EoE does not lead to histologic improvement; however, the long-term use of PPI on symptoms and prevention of complications has not been evaluated.
  
  
  OBJECTIVE
  To evaluate the use of PPI as maintenance therapy in children with EoE.
  
  
  METHODS
  Eosinophilic esophagitis was diagnosed based on initial endoscopic biopsies and persistent eosinophilic inflammation despite PPI therapy. Inclusion criteria included diagnosis of EoE and PPI use as primary maintenance treatment. Patients were excluded if they were treated with dietary or glucocorticoid therapy. Histologic evidence of inflammation as well as degree of subepithelial fibrosis at presentation was compared with most recent biopsies while receiving PPI therapy.
  
  
  RESULTS
  Thirty-eight patients (30 males and 8 females; average age 6.7 ± 5.4 years) fulfilled inclusion criteria. Duration of follow-up was 3.0 ± 2.4 years. At presentation, vomiting was significantly more frequent in the younger patients, whereas dysphagia occurred more frequently in the older patients. At follow-up, 26 patients were asymptomatic, and the remaining 12 patients' symptoms were significantly improved. No complications of stricture or food impaction were seen. Significant eosinophilic inflammation persisted in 28 patients. No difference in degree of subepithelial fibrosis at diagnosis compared with most recent biopsies. The z-scores of the treated EoE patients significantly improved.
  
  
  CONCLUSIONS
  Patients with EoE treated with PPIs show an improvement in symptoms and z-scores despite persistent eosinophilic inflammation. PPI treatment may be useful maintenance therapy in children with EoE.
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, Cohen Children's Medical Center, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA. jlevine@lij.edu
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Levine
authors.forename: Joanne
authors.initials: J
authors.lastname: Lai
authors.forename: Morris
authors.initials: M
authors.lastname: Edelman
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Schuval
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000188:drug therapy; D004724:Endoscopy; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D064747:Lansoprazole; D008297:Male; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014839:Vomiting / Q000188:drug therapy
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole