title: Oesophageal narrowing on barium oesophagram is more common in adult patients with eosinophilic oesophagitis than PPI-responsive oesophageal eosinophilia.
abstract: To date there have been no clear features that aid in differentiating patients with eosinophilic oesophagitis (EoE) from PPI-responsive oesophageal eosinophilia (PPI-REE). However, barium swallow roentgenography is a more sensitive and specific measure to detect subtle fibrostenotic remodeling changes present in EoE. We aim to characterise any clinical, endoscopic, histiological or barium roentgenographic differences between EoE and PPI-REE.
  
  
  
  To characterise any clinical, endoscopic, histiological or barium roentgenographic differences between EoE and PPI-REE.
  
  
  
  We performed a retrospective cohort analysis on data collected from a tertiary referral centre population from 2010 to 2015. Data from 66 patients with EoE and 28 patients with PPI-REE were analysed. Cases were adults who met consensus guidelines for EOE, and had a barium swallow study within 6 months of the index endoscopy. Clinical, endoscopic, histiological and barium swallow findings were collected.
  
  
  
  Patients with EoE reported similar characteristics as PPI-REE patients, except EoE patients were younger (35.6 vs. 46.6 years; P = 0.011), had earlier symptom onset (29.0 vs. 38.0 years; P = 0.026), and smaller oesophageal diameters on barium swallow (19.5 mm vs. 20; P = 0.042). Patients with EoE were more likely to have distal strictures (EoE 77% vs. 25%; P = 0.02) and, importantly, a greater likelihood of small calibre oesophagus (51.5% vs. 17.9%; P = 0.002). Moreover, EoE patients had a higher probability of developing small calibre oesophagus after 20 years of symptoms (72.3% vs. 30.2%; P = 0.074) compared to PPI-REE patients.
  
  
  
  When compared with eosinophilic oesophagitis, PPI-REE patients demonstrate findings that suggest PPI-responsive oesophageal eosinophilia to be a later onset, less aggressive form of oesophageal stricturing disease than eosinophilic oesophagitis.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Podboy
authors.affiliation: Department of Gastroenterology, Mayo Clinic, Rochester, MN, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Katzka
authors.affiliation: Department of Health Sciences, Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: F
authors.initials: F
authors.lastname: Enders
authors.affiliation: Department of Health Sciences, Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Larson
authors.affiliation: Department of Health Sciences, Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: D
authors.initials: D
authors.lastname: Geno
authors.affiliation: Department of Health Sciences, Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: L
authors.initials: L
authors.lastname: Kryzer
authors.affiliation: Department of Gastroenterology, Mayo Clinic, Rochester, MN, USA.
authors.forename: J
authors.initials: J
authors.lastname: Alexander
mesh_terms: D000328:Adult; D001464:Barium; D004724:Endoscopy; D004802:Eosinophilia / Q000175:diagnosis* / Q000188:drug therapy; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000188:drug therapy; D004940:Esophageal Stenosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors; D001464:Barium