Proton Pump Inhibitor-responsive Esophageal Eosinophilia: Still a Valid Diagnosis?

Javier Molina-Infante; Pedro L. Gonzalez-Cordero; Alfredo J. Lucendo


Curr Opin Gastroenterol. 2017;33(4):285-292. 

In This Article

Proton Pump Inhibitor-ree? Let's Call a Spade a Spade

All the aforementioned data provide no rational basis for making a distinction between patients with symptomatic esophageal eosinophilia based solely on their different response to a single drug. It seems counterintuitive to differentiate responders and nonresponders to PPI therapy when their phenotypic, molecular, mechanistic, and therapeutic features are virtually identical. As such, the requirement to provide a distinct name among indistinguishable patients for the subgroup that responds to PPIs is questionable, at the very least[34] If there is no azathioprine-responsive inflammatory bowel disease (we call it Crohn's disease), short beta agonists-responsive bronchial eosinophilia (we call it asthma) or budesonide-responsive colonic lymphocytosis (we call it microscopic colitis), why should we continue to distinguish PPI-REE from EoE?

A recent international consensus position paper endorsed by pediatricians, allergists, immunologists and adult gastroenterologists, has recently supported this concept of abandoning the artificial term 'PPI-responsive esophageal eosinophilia,'.[35] Contrary to 2011 guidelines, a response to PPI cannot be considered a diagnostic exclusion criterion for EoE anymore, since PPI therapy is now deemed to be a potential therapeutic agent for all patients with clinical, endoscopic and histologic features of EoE. All these changes in diagnostic criteria, relying on clinical and histologic features of EoE rather than its response to a medication, have been included in the soon to be published, first evidence-based guidelines on the diagnosis and management of EoE in children and adults.[36] These updated diagnostic criteria for EoE are displayed in Table 1 .