title: The efficacy of step-down therapy in adult patients with proton pump inhibitor-responsive oesophageal eosinophilia.
abstract: BACKGROUND
  Proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE) is common in patients with suspected eosinophilic oesophagitis (EoE). However, the long-term efficacy of PPIs and the best maintenance doses are yet to be defined.
  
  
  OBJECTIVE
  To evaluate the durability of the response to PPI therapy after tapering PPI doses in PPI-REE patients.
  
  
  METHODS
  Prospective study conducted on PPI-REE patients. Upon complete remission on high-dose PPI therapy (omeprazole 40 mg b.d. for 8 weeks), PPI doses were tapered followed by an endoscopic procedure after each dose reduction. The primary outcomes were sustained clinical and histological remission (<15 eos/HPF) after decreasing PPI doses.
  
  
  RESULTS
  From a total of 121 patients with suspected EoE, 40 (33%) achieved complete remission on high-dose PPIs and were given a diagnosis of PPI-REE. No patient in histological remission showed symptom relapse, but half of patients with relapsing oesophageal inflammation were in clinical remission. After reduction to omeprazole 40 mg once daily, 38/31 (81%) remained in complete remission. Among these latter patients, 15/18 (83%) were kept in remission with omeprazole 20 mg once daily. As for side effects, only asymptomatic hypertransaminasemia and oesophageal candidiasis were observed in two patients while receiving high doses of omeprazole.
  
  
  CONCLUSIONS
  Most PPI-responsive oesophageal eosinophilia patients show sustained clinical and histological remission with daily PPI doses equal to or below 40 mg of omeprazole. As adverse effects only appeared with the highest dose of omeprazole, it would be advisable to individualise the dose of PPIs for each patient, lowering it to the minimum capable of maintaining the disease controlled.
authors.affiliation: Department of Allergy Hospital, General Universitario de Ciudad Real, Ciudad Real, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Gómez-Torrijos
authors.affiliation: Department of Allergy Hospital, General Universitario de Ciudad Real, Ciudad Real, Spain.
authors.forename: R
authors.initials: R
authors.lastname: García-Rodríguez
authors.affiliation: Department of Allergy Hospital, General Universitario de Ciudad Real, Ciudad Real, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Castro-Jiménez
authors.affiliation: Department of Gastroenterology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rodríguez-Sanchez
authors.affiliation: Department of Allergy Hospital, General Universitario de Ciudad Real, Ciudad Real, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: Méndez Díaz
authors.affiliation: Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Molina-Infante
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004724:Endoscopy; D057765:Eosinophilic Esophagitis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole