title: Eosinophilic esophagitis: is it also a surgical disease?
abstract: BACKGROUND
  Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disease with esophageal dysfunction and eosinophil-predominant inflammation. An association between EoE and gastro-esophageal reflux disease (GERD) has not been well established.
  
  
  OBJECTIVE
  The aim was to evaluate patients with EoE who underwent pH-Multichannel Intraluminal Impedance (pH-MII), investigating proton-pump-inhibitors (PPI) therapy/anti-reflux surgery requirement.
  
  
  METHODS
  Twenty-five patients [mean age 7.6 (range 1-17 years)] with EoE underwent pH-MII. The children were then divided into Group 1 (pathological pH-MII) and Group 2 (normal pH-MII). PPI was administered for two months in Group 1 and in those children in Group 2 unresponsive to standard EoE therapy (diet and corticosteroids). All patients underwent endoscopy and clinical follow-up. Data are described as mean (range).
  
  
  RESULTS
  Group 1 (n=16, M:F=14:2) had mean reflux index (RI) 13.9% (0.8%-53.4%) with a mean number of total reflux episodes (RE) of 65.8 (14-341). Group 2 (n=9, M:F=6:3) had a mean RI 1.2% (0.2%-2.7%) with a mean number of total RE of 27.4 (14-39). There was a histological response to repeated cycles of PPI in 11/16 (69%) children in Group 1 and 4/9 (44%) children in Group 2. Fundoplication, because of dependence on PPI, was required in 4/11 PPI-responders in Group 1, allowing discontinuation without relapse of EoE.
  
  
  CONCLUSIONS
  The use of PPI is suggested in EoE at time of diagnosis in addition to standard treatment and may even have benefit in children who do not appear to have significant GERD but are unresponsive to standard therapy.
authors: Digestive Surgery and Endoscopy Unit, Pediatric Hospital and Research Institute Bambino Gesù-IRCCS, Rome, 00165, Rome, Italy. rea.fra@libero.it
authors: Francesca
authors: F
authors: Rea
authors: Tamara
authors: T
authors: Caldaro
authors: Renato
authors: R
authors: Tambucci
authors: Erminia F
authors: EF
authors: Romeo
authors: Claudia
authors: C
authors: Caloisi
authors: Filippo
authors: F
authors: Torroni
authors: Giovanni Federici
authors: GF
authors: di Abriola
authors: Francesca
authors: F
authors: Foschia
authors: Paola
authors: P
authors: Francalanci
authors: Luigi
authors: L
authors: Dall'Oglio
authors: Paola
authors: P
authors: De Angelis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000188:drug therapy*; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors