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Esophageal Eosinophilic Infiltration Responsive to PPI Rx

EoE may be overestimated without clinical, pathologic follow-up of response to proton pump inhibition

THURSDAY, Feb. 24 (HealthDay News) -- Proton pump inhibitor (PPI) therapy may bring about remission of esophageal eosinophilic infiltration (EEI), calling into question the use of EEI as a histological tool to diagnose eosinophilic esophagitis (EoE), according to a study published in the February issue of Clinical Gastroenterology and Hepatology.

Javier Molina-Infante, M.D., from Hospital San Pedro de Alcantara in Caceres, Spain, and colleagues examined data from upper-middle esophagus biopsies taken from 712 adults with upper gastrointestinal symptoms who were referred for endoscopy. Patients with EEI were treated with 20 mg rabeprazole twice a day for two months. EoE was characterized by persistent symptoms and more than 15 eosinophils per high power field following PPI therapy.

The investigators found 35 patients who had EEI, 75 percent of whom achieved clinicopathological remission following PPI therapy. Of the patients who achieved remission, 17 had a gastroesophageal reflux disease-like profile and nine had an EoE-like profile. The PPI response was 50 percent in patients with an EoE-like profile. In EEI patients with abnormal pH monitoring, 80 percent achieved complete remission after PPI therapy; whereas, 33 percent of those with normal pH monitoring achieved remission. Using higher histological cut-off values increased specificity and positive prediction for EoE.

"Diagnosis of EoE based only on histopathology and normal pH monitoring has a poor accuracy when compared with a PPI trial," the authors write.

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