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Proton pump inhibitor therapy reverses endoscopic features of fibrosis in eosinophilic esophagitis

      Abstract

      Background

      Long-standing inflammation leads to esophageal remodeling with stricture formation in patients with eosinophilic esophagitis (EoE). The ability of proton pump inhibitors (PPI) to reverse endoscopic features of fibrosis is still unknown.

      Objective

      To investigate the effect of a short course of PPI treatment in reducing endoscopic findings indicative of esophageal fibrosis in EoE patients.

      Methods

      Cross-sectional analysis of the EoE CONNECT registry. Patients who received PPI to induce EoE remission were evaluated. Endoscopic features were graded using the EoE Endoscopic Reference Score (EREFS), with rings and strictures indicating fibrosis. Results were compared to those from patients treated with swallowed topic corticosteroids (STC).

      Results

      Clinico-histological remission was achieved in 83/166 adult patients treated with PPI (50%) and in 65/79 (82%) treated with STC; among responders, 60 (36%) and 57 (72%) patients respectively achieved deep histological remission (<5 eosinophils/hpf). At baseline, mean±SD EREFS was lower in patients treated with PPI compared to those who received STC (p < 0.001). Short term treatment significantly reduced EREFS scores in patients treated either with PPI or STC as well as rings and strictures. Among patients treated with PPI, deep histological remission (<5 eosinophils/hpf) provided further reduction in total EREFS score.

      Conclusion

      Effective PPI therapy for EoE significantly reduced endoscopic esophageal fibrosis in the short term.

      Keywords

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      Linked Article

      • Reversal of fibrosis in eosinophilic esophagitis: Another feather in the PPI cap?
        Digestive and Liver DiseaseVol. 53Issue 11
        • Preview
          Eosinophilic esophagitis (EoE) is an immune-antigen-mediated disease characterized by a transmural eosinophil-predominant inflammation of the esophagus [1]. Chronic uncontrolled eosinophilic inflammation ultimately leads to remodeling and alters the structure and function of the esophagus [2,3], with dysmotility [4], esophageal rigidity [5], progressive dysphagia and food impaction and, finally, stricture formation [6]. The endoscopic signs of EoE remodeling can be obvious with fibrostenotic features such as rings and strictures that cause food impaction [7,8].
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