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Dose May Matter: CYP2C19 Genotype and Proton-Pump Inhibitor Response in Pediatric Eosinophilic Esophagitis

Paroma Bose1, Chizoba N Umeweni2, Anthony Perkins3

  • 1Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, Indiana, USA.

The American Journal of Gastroenterology
|July 13, 2026
PubMed

Insights

Proton pump inhibitor (PPI) metabolism, determined by CYP2C19 genotype, impacts treatment success in pediatric eosinophilic esophagitis (EoE). Slow metabolizers showed better histologic response to high-dose PPIs.

Area of Science:

  • Pharmacogenomics
  • Gastroenterology
  • Pediatric Medicine

Background:

  • Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease.
  • Proton pump inhibitors (PPIs) are a first-line treatment for EoE.
  • The role of CYP2C19 genotype in PPI metabolism and EoE treatment response is not well understood.

Purpose of the Study:

  • To investigate the association between CYP2C19 genotype-based PPI metabolism and treatment response in pediatric patients with EoE.

Main Methods:

  • A cohort study was conducted involving pediatric subjects diagnosed with active histologic EoE.
  • Subjects received PPI therapy, and their whole blood samples were analyzed for CYP2C19 genotype.

Main Results:

  • Intermediate and slow PPI metabolizers on high-dose PPIs (>1mg/kg/day) showed significantly higher rates of histologic response compared to normal and rapid metabolizers.
  • No ultra-rapid metabolizers achieved a histologic response to PPI therapy.

Conclusions:

  • CYP2C19 genotype influences PPI efficacy in treating pediatric EoE.
  • Genotyping for CYP2C19 may enable personalized PPI dosing strategies for improved EoE management.
Abstract

Keywords:
CYP2C19eosinophilic esophagitispediatricsproton pump inhibitor

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