Schroeder, Shauna and Capocelli, Kelley E. and Masterson, Joanne C. and Harris, Rachel and Protheroe, Cheryl and Lee, James J. and Furuta, Glenn T. (2013) Effect of Proton Pump Inhibitor on Esophageal Eosinophilia. Journal of Pediatric Gastroenterology and Nutrition, 56 (2). pp. 166-172. ISSN 1536-4801

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Abstract

Objective: Differentiation between the common etiologies of dense esophageal eosinophilia such as gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can be difficult. We hypothesized that histologic features may provide diagnostic clues concerning the etiology of esophageal eosinophilia. Methods: We performed a retrospective chart review of 204 children with the diagnosis of esophagitis characterized by 15 eosinophils (eos) per highpower field (HPF) in at least 1 biopsy. We then restricted our analysis to subjects who had received at least 8 weeks of only proton pump inhibitors (PPIs) followed by endoscopy and who had a clinicopathologic response to this treatment. Symptoms, endoscopic findings, and pathologic descriptions were reviewed and an eosinophil peroxidase (EPX) index was determined to assess for degranulation/eosinophil activation. Results: Of the 204 identified charts, 7 subjects identified met the inclusion criteria. Five of these 7 patients showed a clinicopathologic response to PPIs after their follow-up endoscopy, (mean peak eosinophil count: 92 vs 5 eos/HPF, and EPX index: 39.2 vs 14.6, pre- and posttreatment, respectively). Two patients experienced initial resolution of symptoms and esophageal eosinophilia with PPI therapy; however, within 17–23 months they redeveloped symptoms and esophageal eosinophilia while receiving PPI therapy at the time of a third endoscopy (mean peak eosinophil count: 40 vs 11 vs 36 eos/HPF, and EPX index: 44 vs 21 vs 36.5, pre-, post- and posttreatment, respectively). No clinicopathologic features or degranulation patterns differentiated subjects with GERD/PPI responsive esophageal eosinophilia from those who had transient response to PPI treatment. Conclusions: No clinicopathologic features differentiated subjects who responded to PPI treatment. PPI treatment can be helpful to exclude GERD and PPI responsive esophageal eosinophilia but long-term followup is critical in the management of esophagitis.

Item Type:	Article
Keywords:	eosinophil; eosinophil peroxidase; gastroesophageal reflux disease; histopathology;
Academic Unit:	Faculty of Science and Engineering > Biology
Item ID:	12491
Identification Number:	https://doi.org/10.1097/MPG.0b013e3182716b7a
Depositing User:	Joanne Masterson
Date Deposited:	27 Feb 2020 14:33
Journal or Publication Title:	Journal of Pediatric Gastroenterology and Nutrition
Publisher:	Lippincott, Williams & Wilkins
Refereed:	Yes
URI:	Publisher
Use Licence:	This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available here

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