title: Interactions between gastro-oesophageal reflux disease and eosinophilic oesophagitis.
abstract: Gastro-oesophageal reflux disease (GORD) is the most common oesophageal disorder, whereas eosinophilic oesophagitis (EoE) is an emerging disease unresponsive to PPI therapy. Updated guidelines in 2011 described proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), a novel phenotype in EoE patients who were responsive to PPIs. This article aims to update the complex interplay between GORD, EoE and PPIs. Oesophageal mucosal integrity is diffusely impaired in EoE and PPI-REE patients. PPI-REE might occur with either normal or pathological pH monitoring. The genetic hallmark of EoE is overlapped in PPI-REE, but not in GORD. PPIs can partially restore epithelial integrity and reverse allergic inflammation gene expression in PPI-REE. Acid hypersensitivity in EoE patients may explain symptomatic but not histological response on PPIs. Unsolved issues with PPI-REE are whether oesophageal barrier impairment is the cause or the effect of oesophageal eosinophilia and whether PPIs primarily targets barrier integrity or oesophageal inflammation.
authors.affiliation: Department of Gastroenterology. Hospital San Pedro de Alcantara, Caceres, Spain. Electronic address: xavi_molina@hotmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Bram D
authors.initials: BD
authors.lastname: van Rhijn
mesh_terms: D057765:Eosinophilic Esophagitis / Q000503:physiopathology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D015870:Gene Expression; D006801:Humans; D010641:Phenotype; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors
keywords: Eosinophilic oesophagitis; GORD; Proton pump inhibitor-responsive oesophageal eosinophilia