EoE Recurrence on PPI Maintenance Therapy: You Do Not Know if You Do Not Look!
Ryan Alexander1,2, Blake Kassmeyer3, Ryan Lennon3
1Department of Internal Medicine, Mayo Clinic Rochester, Rochester, USA. alexander.ryan2@mayo.edu.
Digestive Diseases and Sciences
|October 15, 2024
Summary
Proton pump inhibitor (PPI) maintenance therapy for eosinophilic esophagitis (EoE) shows a 44% histologic recurrence rate. Regular surveillance is crucial for patients with EoE on PPIs to monitor treatment effectiveness.
Area of Science:
- Gastroenterology
- Immunology
- Esophageal Diseases
Background:
- Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease.
- Data on the histologic recurrence of EoE during proton pump inhibitor (PPI) maintenance therapy are limited.
Purpose of the Study:
- To evaluate the rate of histologic recurrence in patients with EoE receiving PPI maintenance therapy.
- To assess the impact of PPI dosing strategies on histologic outcomes in EoE.
Main Methods:
- Retrospective review of 101 patients diagnosed with PPI-responsive EoE.
- Analysis of follow-up esophagogastroduodenoscopy (EGD) with biopsies to assess histologic remission or recurrence.
Main Results:
- 51% of patients underwent follow-up biopsies.
- Histologic recurrence was observed in 44% of patients.
- Among patients on twice-daily PPIs, 33% experienced recurrence, often asymptomatically.
Conclusions:
- A significant proportion of EoE patients on PPI maintenance therapy experience histologic recurrence.
- Serial clinical, endoscopic, and histologic surveillance is beneficial for managing EoE patients on PPIs.
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