Once PPIs Work for Esophageal Eosinophilia, Then What?

A step-down approach may work to determine appropriate dose and duration but requires longer-term study.

National guidelines recommend that clinicians rule out proton-pump inhibitor (PPI)–responsive esophageal eosinophilia (EE) before diagnosing eosinophilic esophagitis (EoE; NEJM JW Gastroenterol Aug 2013 and Am J Gastroenterol 2013; 108:679). But once a patient with suspected EoE responds to a PPI, what dose should we recommend, and for how long?

To answer this question, researchers prospectively evaluated outcomes of a step-down approach to PPI therapy in 40 patients identified with PPI-responsive EE. All participants had achieved complete symptomatic and endoscopic response to omeprazole 40 mg twice daily for ≥2 months. Endoscopy was performed after each PPI dose adjustment but not until at least 8 weeks after the adjustment.

Initially, 38 p…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors