title: Effect of proton pump inhibitor on esophageal eosinophilia.
abstract: OBJECTIVE
  Differentiation between the common etiologies of dense esophageal eosinophilia such as gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can be difficult. We hypothesized that histologic features may provide diagnostic clues concerning the etiology of esophageal eosinophilia.
  
  
  METHODS
  : We performed a retrospective chart review of 204 children with the diagnosis of esophagitis characterized by ≥ 15 eosinophils (eos) per high-power field (HPF) in at least 1 biopsy. We then restricted our analysis to subjects who had received at least 8 weeks of only proton pump inhibitors (PPIs) followed by endoscopy and who had a clinicopathologic response to this treatment. Symptoms, endoscopic findings, and pathologic descriptions were reviewed and an eosinophil peroxidase (EPX) index was determined to assess for degranulation/eosinophil activation.
  
  
  RESULTS
  Of the 204 identified charts, 7 subjects identified met the inclusion criteria. Five of these 7 patients showed a clinicopathologic response to PPIs after their follow-up endoscopy, (mean peak eosinophil count: 92 vs 5 eos/HPF, and EPX index: 39.2 vs 14.6, pre- and posttreatment, respectively). Two patients experienced initial resolution of symptoms and esophageal eosinophilia with PPI therapy; however, within 17-23 months they redeveloped symptoms and esophageal eosinophilia while receiving PPI therapy at the time of a third endoscopy (mean peak eosinophil count: 40 vs 11 vs 36 eos/HPF, and EPX index: 44 vs 21 vs 36.5, pre-, post- and posttreatment, respectively). No clinicopathologic features or degranulation patterns differentiated subjects with GERD/PPI responsive esophageal eosinophilia from those who had transient response to PPI treatment.
  
  
  CONCLUSIONS
  No clinicopathologic features differentiated subjects who responded to PPI treatment. PPI treatment can be helpful to exclude GERD and PPI responsive esophageal eosinophilia but long-term follow-up is critical in the management of esophagitis.
authors: Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO 80045, USA.
authors: Shauna
authors: S
authors: Schroeder
authors: Kelley E
authors: KE
authors: Capocelli
authors: Joanne C
authors: JC
authors: Masterson
authors: Rachel
authors: R
authors: Harris
authors: Cheryl
authors: C
authors: Protheroe
authors: James J
authors: JJ
authors: Lee
authors: Glenn T
authors: GT
authors: Furuta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D047209:Eosinophil Peroxidase / Q000378:metabolism; D004802:Eosinophilia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D004804:Eosinophils / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors; D047209:Eosinophil Peroxidase