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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Article info
Publication history
Published online: June 10, 2021
Accepted:
May 14,
2021
Received:
November 12,
2020
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Reversal of fibrosis in eosinophilic esophagitis: Another feather in the PPI cap?Digestive and Liver DiseaseVol. 53Issue 11
- PreviewEosinophilic 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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