Dranove JE, Horn DS, Davis MA, Kernek KM, Gupta SK. J Pediatr. 2009;154(1):96–100
PURPOSE OF THE STUDY. To determine predictors of the histologic response to proton pump inhibitor (PPI) therapy among children with significant esophageal eosinophilia (SEE), defined as ≥15 eosinophils per high-powered field (hpf) on esophageal mucosal biopsy (EMB).
STUDY POPULATION. Patients between the ages of 1 and 18 years who underwent esophagogastroduodenoscopy between 1999 and 2006 were eligible for the study. Indications for esophagogastroduodenoscopy included regurgitation, vomiting, heartburn, abdominal pain, dysphagia, and sensation of food impaction. Patients with SEE were eligible for this investigation if they were treated with a PPI (omeprazole, esomeprazole, or lansoprazole) and underwent repeat esophagogastroduodenoscopy to assess the response to the PPI. Patients were excluded if they were receiving corticosteroid, dietary elimination, or montelukast therapy for any indication.
METHODS. Response to PPI therapy among children with SEE treated with a PPI who underwent repeat EMB was studied retrospectively. Response was defined as <5 eosinophils per hpf on repeat EMB. Characteristics of responders and nonresponders were analyzed.
RESULTS. Of 326 patients diagnosed with SEE over a 7-year period, 43 (mean age: 8.5 years; male: 67%) met inclusion criteria. After PPI therapy, 17 patients (40%) were responders. There were no significant differences in demographic features, presenting symptoms, endoscopic findings, or histologic findings between responders and nonresponders. Among patients with 15 to 20 eosinophils per hpf on EMB, 50% were responders; among patients with >20 eosinophils per hpf on EMB, 29% were responders. Seven (41%) of 17 patients with abnormal pH monitoring and 5 (45%) of 11 patients with normal monitoring were responders.
CONCLUSIONS. Forty percent of patients with SEE demonstrated histologic response to PPI therapy. None of the clinical characteristics evaluated predicted response, and response was not dependent on pH study results. The role of PPI therapy in treating SEE warrants further prospective investigation.
REVIEWER COMMENTS. Esophageal eosinophilia has become an increasing clinical concern in the pediatric population. These investigators set out to determine predictors of histologic response to PPI therapy among children with SEE. They correctly identified significant limitations in their retrospective study. For example, the treatment and evaluation of these patients were not standardized at their institution. In addition, not all patients were treated with PPI, doses were not uniform, and not all patients treated with PPI underwent repeat endoscopy. A selection bias cannot be excluded with this study design. Prospective controlled investigations examining the role of PPI, as well as other therapies (eg, enteral corticosteroid therapy), in patients with SEE are definitely needed.
- Copyright © 2009 by the American Academy of Pediatrics