Eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia have similar clinical, endoscopic and histological findings.
BACKGROUND
Some patients with a phenotypic appearance of eosinophilic oesophagitis (EoE) respond histologically to PPI, and are described as having PPI-responsive oesophageal eosinophilia (PPI-REE). It is unclear if PPI-REE is a GERD-related phenomenon, a subtype of EoE, or a completely unique entity.


OBJECTIVE
To compare demographic, clinical and histological features of EoE and PPI-REE.


METHODS
Two databases were reviewed from the Walter Reed and Swiss EoE databases. Patients were stratified into two groups, EoE and PPI-REE, based on recent EoE consensus guidelines. Response to PPI was defined as achieving less than 15 eos/hpf and a 50% decrease from baseline following at least a 6-week course of treatment.


RESULTS
One hundred and three patients were identified (63 EoE and 40 PPI-REE; mean age 40.2 years, 75% male and 89% Caucasian). The two cohorts had similar dysphagia (97% vs. 100%, P = 0.520), food impaction (43% vs. 35%, P = 0.536), and heartburn (33% vs. 32%, P = 1.000) and a similar duration of symptoms (6.0 years vs. 5.8 years, P = 0.850). Endoscopic features were also similar between EoE and PPI-REE; rings (68% vs. 68%, P = 1.000), furrows (70% vs. 70%, P = 1.000), plaques (19% vs. 10%, P = 0.272), strictures (49% vs. 30%, P = 0.066). EoE and PPI-REE were similar in the number of proximal (39 eos/hpf vs. 38 eos/hpf, P = 0.919) and distal eosinophils (50 vs. 43 eos/hpf, P = 0.285).


CONCLUSIONS
EoE and PPI-responsive oesophageal eosinophilia are similar in clinical, histological and endoscopic features and therefore are indistinguishable without a PPI trial. Further studies are needed to determine why a subset of patients with oesophageal eosinophilia respond to PPI.
Gastroenterology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
F J
FJ
Moawad
A M
AM
Schoepfer
E
E
Safroneeva
M R
MR
Ally
Y-J
YJ
Chen
C L
CL
Maydonovitch
R K H
RK
Wong
D000328:Adult; D016208:Databases, Factual; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology; D004724:Endoscopy; D004802:Eosinophilia / Q000188:drug therapy / Q000503:physiopathology*; D057765:Eosinophilic Esophagitis / Q000503:physiopathology*; D004804:Eosinophils / Q000473:pathology; D005260:Female; D006356:Heartburn / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D054328:Proton Pump Inhibitors