title: The outcome of patients with oesophageal eosinophilic infiltration after an eight-week trial of a proton pump inhibitor.
abstract: BACKGROUND
  Current diagnostic guidelines recommend that eosinophilic oesophagitis (EoE) should be diagnosed only after GERD is excluded by a lack of response to a trial of acid suppression. There is limited information available providing outcome data about the effectiveness of this approach.
  
  
  OBJECTIVE
  To examine the impact of double-dose proton pump inhibitor (PPI) therapy on symptoms, endoscopic and histological features in patients with documented oesophageal eosinophilia consistent with EoE (≥15 eosinophils/high-power field).
  
  
  METHODS
  Sixty consecutive symptomatic patients with documented oesophageal eosinophilia received open-label omeprazole 20 mg orally twice daily before meals for 8 weeks. Clinical, endoscopic and histological (resolution: 0-5 eosinophils/HPF, partial improvement: 5-14 eosinophils/HPF), or no improvement: (≥15 eosinophils/HPF) evaluation was repeated at the end of this period. An expert GI pathologist, unaware of the study aims, reviewed all slides.
  
  
  RESULTS
  Clinical improvement occurred in 43 (71.6%), endoscopic signs were reduced in 34 (61.8%) and normalised in 12 (21.8%), and histologically, 34 (56.6%) improved, while 15 (25%) obtained complete resolution. Overall, 22 patients (36.7%) obtained both complete clinical and histological remission.
  
  
  CONCLUSIONS
  More than 50% of patients with documented oesophageal eosinophilic infiltration in the EoE range improved when treated with a double-dose PPI trial for 8 weeks. These findings support the published guidelines recommending a PPI trial prior to diagnosing EoE, and confirm the existence of an eosinophilic oesophageal infiltrationPPI-responsive population.
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: G
authors.initials: G
authors.lastname: Vazquez-Elizondo
authors.forename: S
authors.initials: S
authors.lastname: Ngamruengphong
authors.forename: M
authors.initials: M
authors.lastname: Khrisna
authors.forename: K R
authors.initials: KR
authors.lastname: Devault
authors.forename: N J
authors.initials: NJ
authors.lastname: Talley
authors.forename: S R
authors.initials: SR
authors.lastname: Achem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D004802:Eosinophilia / Q000188:drug therapy; D057765:Eosinophilic Esophagitis / Q000188:drug therapy* / Q000503:physiopathology; D004804:Eosinophils / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole