title: Proton pump inhibitors for eosinophilic oesophagitis.
abstract: OBJECTIVE
  To review the significance and plausible mechanisms underlying 'proton pump inhibitor (PPI) responsive oesophageal eosinophilia' in eosinophilic oesophagitis (EoE).
  
  
  RESULTS
  EoE is defined as an immune-mediated clinicopathologic condition characterized by oesophageal dysfunction and eosinophil-predominant inflammation. This new conceptual definition has been proposed partly due to a recently identified disease phenotype called 'PPI-responsive oesophageal eosinophilia'. Emerging data support the possibility that this condition represents a clinical response to anti-inflammatory properties of PPIs that are independent of effects on gastric acid.
  
  
  CONCLUSIONS
  Currently, the diagnosis of EoE is reserved for patients with oesophageal eosinophilia and symptoms that do not respond to PPIs. This practice may not be appropriate, however, both because gastric acid suppression by PPIs might benefit EoE patients and because PPIs have anti-inflammatory properties that also might benefit EoE patients. More studies are sorely needed to understand the mechanisms underlying PPI-responsive oesophageal eosinophilia. Currently, a favourable response to PPI therapy should not be regarded as a proof of an underlying acid peptic disorder such as gastroesophageal reflux disease (GERD) nor should it preclude a diagnosis of EoE. Furthermore, it seems prudent to recommend a trial of PPI therapy for patients with oesophageal eosinophilia and symptoms, even when the diagnosis of EoE seems clear-cut.
authors: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA. edaire.cheng@utshouthwestern.edu
authors: Edaire
authors: E
authors: Cheng
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D054328:Proton Pump Inhibitors