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Comment
. 2022 Sep;54(9):1179-1185.
doi: 10.1016/j.dld.2022.03.006. Epub 2022 Apr 8.

Long-term efficacy of proton pump inhibitors as a treatment modality for eosinophilic esophagitis

Kisan P Thakkar  1 , Mark Fowler  2 , Staci Keene  2 , Alina Iuga  2 , Evan S Dellon  3
Affiliations
Comment

Long-term efficacy of proton pump inhibitors as a treatment modality for eosinophilic esophagitis

Kisan P Thakkar et al. Dig Liver Dis. 2022 Sep.

Abstract

Background: Proton pump inhibitors (PPIs) are a first-line treatment for EoE, but data are limited concerning response durability. We aimed to determine long-term outcomes in EoE patients responsive to PPI-therapy.

Methods: We conducted a retrospective cohort study of newly diagnosed adults with EoE who had initial histologic response (<15 eosinophils per high-power-field) to PPI-only therapy. We extracted data regarding their subsequent clinical course and outcomes. We compared findings between the initial PPI-response endoscopy and the final endoscopy, and assessed factors associated with loss of PPI response.

Results: Of 138 EoE patients with initial histologic response to PPI, 50 had long-term endoscopic follow-up, 40 had clinical follow-up, 10 changed treatments, and 38 had no long-term follow-up. Of those with endoscopic follow-up, mean follow-up-time was 3.6 ± 2.9 years; 30 and 32 patients (60%; 64%) maintained histologic and symptom responses, respectively. However, fibrotic endoscopic findings of EoE were unchanged. Younger age (aOR 1.05, 95% CI: 1.01-1.11) and dilation prior to PPI treatment (aOR 0.21, 95% CI: 0.05-0.83) were the only factors associated with long-term loss of PPI response.

Conclusions: Long-term histologic and clinical response rates for PPI therapy were 60% and 64%, respectively. Younger age and dilation at baseline were associated with histologic loss of response. These data can inform long-term EoE treatment selection.

Keywords: Eosinophilic esophagitis; Histology; Outcomes; Proton pump inhibitor; Response rates.

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Conflict of interest statement

Declaration of Competing Interest Dr. Dellon is a consultant for Abbott, Abbvie, Adare/ Ellodi, Aimmune, Allakos, Amgen, Arena, AstraZeneca, Avir, Biorasi, Calypso, Celgene/Receptos/BMS, Celldex, Eli Lilly, EsoCap, GSK, Gossamer Bio, InveniAI, Landos, LucidDx, Morphic, Nutricia, Parexel/Calyx, Phathom, Regeneron, Revolo, Robarts/Alimentiv, Salix, Sanofi, Shire/Takeda, Target RWE, receives research funding from Adare/Ellodi, Allakos, Arena, AstraZeneca, GSK, Meritage, Miraca, Nutricia, Celgene/Receptos/BMS, Regeneron, Shire/Takeda, and has received an educational grant from Allakos, Banner, and Holoclara. None of the other authors report and potential conflicts of interest with this study.

Figures

Figure 1:
Figure 1:
Flow-diagram for patient stratification by PPI course and outcomes following endoscopy demonstrating PPI-response.
See this image and copyright information in PMC

Comment on

References

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