ArticleDigestive diseases and sciences2012
Transient PPI responsive esophageal eosinophilia may be a clinical sub-phenotype of pediatric eosinophilic esophagitis.
Article in Digestive diseases and sciences, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 2 of them syntheses that pooled it.
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Who cites it
53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 117 citations in OpenAlex.
- Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference.Gastroenterology · 2018Guideline
- Guideline
- Long-term Outcome of Asymptomatic Esophageal Eosinophilia.Gut and liver · 2024Article
- Disease Burden and Spectrum of Symptoms that Impact Quality of Life in Pediatric Patients with Eosinophilic Esophagitis.Gastro hep advances · 2024Review
- Eosinophilic esophagitis: Immune mechanisms and therapeutic targets.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2022Review
- Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: History, Mechanisms, Efficacy, and Future Directions.Journal of asthma and allergy · 2022Review
- Eosinophilic esophagitis, Barrett's esophagus and esophageal neoplasms in the pediatric patient: a narrative review.Translational gastroenterology and hepatology · 2021Review
- Omeprazole inhibits IgE-mediated mast cell activation and allergic inflammation induced by ingested allergen in mice.The Journal of allergy and clinical immunology · 2020Article
- Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis.Gastroenterology · 2020Review
- Diagnosis and treatment of eosinophilic esophagitis.The Journal of allergy and clinical immunology · 2020Review
- Eosinophilic esophagitis: Current concepts in diagnosis and treatment.World journal of gastroenterology · 2019Review
- Eosinophilic Esophagitis in Esophageal Atresia.Frontiers in pediatrics · 2019Review
- An Evolving Approach to the Diagnosis of Eosinophilic Esophagitis.Gastroenterology & hepatology · 2018Article
- Treatment of eosinophilic esophagitis in the pediatric patient: an evidence-based approach.European journal of pediatrics · 2018Review
- The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis.Frontiers in pediatrics · 2018Review
- Absence of esophageal eosinophilia in a toddler with severe eosinophilic esophagitis.Asia Pacific allergy · 2017Article
- Diagnosis and treatment of eosinophilic esophagitis in clinical practice.Clinical journal of gastroenterology · 2017Review
- Current concepts in eosinophilic esophagitis.Allergo journal international · 2017Review
- Mechanisms of Disease of Eosinophilic Esophagitis.Annual review of pathology · 2016Review
- The Immunologic Mechanisms of Eosinophilic Esophagitis.Current allergy and asthma reports · 2016Review
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEosinophilic esophagitis (EoE) and gastroesophageal reflux (GERD) both cause esophageal eosinophilia. Reports show that esophageal eosinophilia meeting criteria for EoE may respond to acid suppression mono-therapy. Consensus guidelines have termed this entity "PPI-responsive esophageal eosinophilia" (PPIRee) and recommend a trial with proton-pump inhibitors (PPIs) prior to a definitive EoE diagnosis. The mechanisms of PPIRee and whether this represents a sub-phenotype of GERD, a sub-phenotype of EoE, or its own distinct entity remain unclear.
methodsA database search revealed children who had an initial histologic response to PPI monotherapy but had recurrence of esophageal eosinophilia and symptoms despite continued PPI therapy. In order to understand the patterns of esophageal inflammatory cells during PPI therapy we performed quantitative immunohistochemistry for mast cells, CD1a positive antigen presenting cells, and CD45RO memory T cells.
resultsFour pediatric patients (mean age 9.5 years) had a mean peak eosinophil count of 52 eos/hpf which initially resolved completely during PPI mono-therapy. However, despite continued PPI therapy, endoscopic abnormalities and pan-esophageal eosinophilia recurred (mean peak eosinophil count of 64 eos/hpf). There was no seasonal variation or lack of PPI adherence that explained the return of eosinopihlia. Similar to eosinophilia, mastocytosis and CD45RO cells were transiently decreased during PPI therapy.
conclusionPPIs appear to be capable of transiently resolving multiple inflammatory cell subsets including eosinophils, mast cells, and CD45RO cells. Our data suggest that patients with PPIRee should have continued monitoring for EoE during PPI monotherapy. The numbers of patients in whom PPIRee is a transient phenomenon and whether PPIRee represents a sub-phenotype of EoE in children merits further investigation.
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