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

Maintenance Proton Pump Inhibitor Therapy

Until recently, the sustained efficacy of PPI therapy in initial responders to PPIs was limited to two retrospective series comprising six pediatric patients with recurrence of esophageal eosinophilia and symptoms while on maintenance PPI therapy.[37,38] A first long-term follow-up, multicenter study in 2015 including 75 adult patients demonstrated that all patients who temporarily discontinued PPI therapy had symptom and/or histological relapse.[39] The majority of patients (73%) maintained histological remission after at least 1 year on PPIs with the dosage tapered to the minimum effective clinical dose.[39] A CYP2C19 rapid metabolizer genotype and allergic rhinitis were independent predictors of loss of PPI responsiveness. Among relapsers, most regained histological remission after dose escalation, suggesting that some patients continue to require maintenance high-dose PPI treatment.[39] Another recent prospective series has confirmed these findings with a step-down approach (80% of adult patients on sustained remission with tapering PPI doses).[40] A first prospective study in children has also replicated these findings from adults studies, showing that 78% of PPI responders remain in clinico-pathologic remission at 1-year follow up on low maintenance PPI doses.[19]