Proton pump inhibitors for eosinophilic oesophagitis

Area of Science:

• Gastroenterology
• Immunology
• Oesophageal Diseases

Background:

• Eosinophilic oesophagitis (EoE) is an immune-mediated condition causing oesophageal dysfunction and eosinophil inflammation.
• A newly identified phenotype, PPI-responsive oesophageal eosinophilia, challenges traditional EoE diagnostic criteria.
• Proton pump inhibitors (PPIs) may exert anti-inflammatory effects beyond gastric acid suppression.

Purpose of the Study:

• To review the significance of PPI-responsive oesophageal eosinophilia in EoE.
• To explore plausible mechanisms underlying this PPI response.
• To re-evaluate current diagnostic and therapeutic approaches for EoE.

Main Methods:

• Literature review of studies on PPI-responsive oesophageal eosinophilia and EoE.
• Analysis of emerging data on PPI mechanisms of action in oesophageal inflammation.
• Synthesis of current evidence to inform diagnostic and treatment strategies.

Main Results:

• PPI-responsive oesophageal eosinophilia suggests a potential clinical response to PPIs' anti-inflammatory properties.
• This response may be independent of PPIs' effect on gastric acid secretion.
• Current diagnostic criteria for EoE may exclude patients who could benefit from PPI therapy.

Conclusions:

• The diagnosis of EoE should not solely rely on PPI non-responsiveness.
• PPIs might benefit EoE patients through mechanisms other than acid suppression.
• Further research is crucial to elucidate PPI-responsive oesophageal eosinophilia mechanisms and guide clinical practice.
• A trial of PPI therapy is advisable for patients with oesophageal eosinophilia and symptoms, even if EoE appears evident.