Proton pump inhibitor therapy reverses endoscopic features of fibrosis in eosinophilic esophagitis
Pilar Navarro 1 , Emilio J Laserna-Mendieta 2 , Danila Guagnozzi 3 , Sergio Casabona 4 , Antonia Perelló 5 , Edoardo Savarino 6 , Susana de la Riva 7 , José María Olalla 8 , Matteo Ghisa 6 , Natalia Serrano-Moya 1 , Carmen Alcolea-Valero 1 , Guillermo Ortega-Rabbione 9 , Pedro Majano 10 , Cecilio Santander 11 , Ángel Arias 12 , Alfredo J Lucendo 13 , EUREOS EoE CONNECT research group
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.
CITATION Dig Liver Dis. 2021 Nov;53(11):1479-1485. doi: 10.1016/j.dld.2021.05.025. Epub 2021 Jun 10