Document Detail


Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults.
MedLine Citation:
PMID:  20920599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Despite consensus recommendations, eosinophilic esophagitis (EoE) is commonly diagnosed upon esophageal eosinophilic infiltration (EEI; based on ≥ 15 eosinophils per high power field; eo/HPF). We evaluated the prevalence of EEI before and after proton pump inhibitor (PPI) therapy and assessed the accuracy of EEI and pH monitoring analyses.
METHODS: Biopsies were taken from the upper-middle esophagus of 712 adults with upper gastrointestinal symptoms who were referred for endoscopy due to upper gastrointestinal symptoms. Patients with EEI were treated with rabeprazole (20 mg, twice daily) for 2 months. EoE was defined by persistent symptoms and >15 eo/HPF following PPI therapy.
RESULTS: Thirty-five patients (4.9%) had EEI, of whom 55% had a history of allergies, and 70% had food impaction or dysphagia as their primary complaint. Twenty-six EEI patients (75%) achieved clinicopathological remission with PPI therapy; of these, 17 had GERD-like profile (EEI <35 eo/HPF and objective evidence of reflux, based on endoscopy or pH monitoring), and 9 had EoE-like profile (EEI 35-165 eo/HPF, typical EoE symptoms and endoscopic findings). The PPI response was 50% in the EoE-like profile patients. The PPI-response was 50% in EoE-like profile patients. Likewise, PPI-responsive EEI occurred with normal (33%) and pathologic (80%) pH monitoring. Higher histologic cut-off values improved specificity and positive predictive for EoE (35%-35% for >20 eo/HPF; 46%-39% for >24 eo/HPF; 65%-50% for 35 eo/HPF).
CONCLUSIONS: In adults with EEI, 75% of unselected patients and 50% with an EoE phenotype respond to PPI therapy; pH monitoring is poorly predictive of response. Patients with PPI-responsive EEI >35 eo/HPF are phenotypically undistinguishable from EoE patients. EoE might be overestimated without clinical and pathologic follow-up of patient response to PPI.
Authors:
Javier Molina-Infante; Lucia Ferrando-Lamana; Cristina Ripoll; Moises Hernandez-Alonso; Jose M Mateos; Miguel Fernandez-Bermejo; Carmen Dueñas; Nuria Fernandez-Gonzalez; Eva M Quintana; Maria Angeles Gonzalez-Nuñez
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-01
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  9     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-25     Completed Date:  2011-05-31     Revised Date:  2013-04-16    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  110-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain. xavi_molina@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
2-Pyridinylmethylsulfinylbenzimidazoles / therapeutic use*
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Biopsy
Cell Count
Deglutition Disorders / etiology
Eosinophilic Esophagitis / diagnosis*,  drug therapy*
Eosinophils / pathology
Esophageal pH Monitoring
Esophagoscopy
Esophagus / pathology
Female
Food
Gastroesophageal Reflux / diagnosis
Humans
Hypersensitivity / epidemiology
Male
Middle Aged
Mucous Membrane / pathology
Multivariate Analysis
Predictive Value of Tests
Prospective Studies
Proton Pump Inhibitors / therapeutic use*
Sensitivity and Specificity
Young Adult
Chemical
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Proton Pump Inhibitors; 32828355LL/rabeprazole
Comments/Corrections
Comment In:
Nat Rev Gastroenterol Hepatol. 2011 Apr;8(4):180   [PMID:  21595056 ]
Clin Gastroenterol Hepatol. 2011 Feb;9(2):99-101   [PMID:  21070874 ]

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