Eosinophilic Oesophagitis and Proton Pump Inhibitor-Responsive Oesophageal Eosinophilia Have Similar Clinical, Endoscopic and Histological Findings

F. J. Moawad; A. M. Schoepfer; E. Safroneeva‡, M. R. Ally; Y.-J. Chen; C. L. Maydonovitch; R. K. H. Wong

Disclosures

Aliment Pharmacol Ther. 2014;39(6):603-608. 

In This Article

Results

A total of 103 patients were included in the study (63 EoE and 40 PPI-REE; mean age 40.2 years ± 12.9, 75% male, and 89% Caucasian). There were 66 patients from Walter Reed and 37 from SEED. In comparing patients between the two institutions, Walter Reed patients were slightly older in age (42 years ± 12 vs. 36 years ± 13, P = 0.024) and reported symptoms for a longer period of time (92 months ± 76 vs. 35 months ± 23, P < 0.001). The groups were similar in gender (% male: 74% vs. 76%, P = 0.535), race (% Caucasian: 88% vs. 92%, P = 0.641) and proportion of patients with PPI-REE (36% vs. 43%, P = 0.316). All the patients in the Walter Reed cohort were treated with Esomeprazole 40 mg twice daily. In the Swiss cohort, 26 patients were treated with Esomeprazole 40 mg twice daily and 13 with Pantoprazole 40 mg twice daily. Clinical presentation and histological features were similar between the two institutions. With regard to endoscopic features, concentric rings and longitudinal furrows were similar between the two study sites; however, white plaques (27% vs. 9%, P = 0.018) and strictures (62% vs. 30%, P = 0.003) were more common in Swiss patients.

Within the entire study cohort, there was no significant difference in demographics between EoE and PPI-REE (age 40 years ± 13 vs. 41 years ± 12, P = 0.767; male 81% vs. 65%, P = 0.102; Caucasian 91% vs. 88%, P = 0.436). Among the 16 patients with PPI-REE who underwent 24 h pH monitoring, no patients had GERD. The two cohorts were similar regarding the presentation of dysphagia (97% vs. 100%, P = 0.520), food impaction (43% vs. 35%, P = 0.536) and heartburn (33% vs. 32%, P = 1.000). Duration of symptoms was similar between EoE and PPI-REE (6.0 years vs. 5.8 years, P = 0.850) (Table 1). With regard to atopic history, EoE patients had significantly less allergic rhinitis compared with PPI-REE (36% vs. 58%, P = 0.041). However, the cohorts were similar in asthma (29% vs. 30%, P = 1.000), food allergies (35% vs. 42%, P = 0.533) and eczema (13% vs. 15%, P = 0.774).

Endoscopic features were also similar between EoE and PPI-REE (Figure 1), including concentric rings (68% vs. 68%, P = 1.000), longitudinal furrows (70% vs. 70%, P = 1.000), white plaques (19% vs. 10%, P = 0.272), strictures (49% vs. 30%, P = 0.066), Schatzki's rings (27% vs. 40%, P = 0.197) and erosive oesophagitis (14% vs. 13%, P = 1.000). Dilation was performed in 54% of EoE vs. 43% of PPI-REE patients, P = 0.314). No complications from dilation occurred in any patient. EoE and PPI-REE were similar in the number of proximal (39 ± 36 eos/hpf vs. 38 ± 23 eos/hpf, P = 0.919) and distal eosinophils (50 ± 32 vs. 43 ± 28 eos/hpf, P = 0.285).

Figure 1.

Example of EoE and PPI-REE cases. This EoE patient demonstrated concentric rings (a), white plaques (b), and dense eosinophilia (c), which persisted following an 8-week course of PPI. This PPI-REE patient had concentric rings (d), white plaques (e) and dense eosinophilia, which resolved following a course of PPI therapy.

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