Evidence map›Paper›PMID 37004219›Full record

ArticleJournal of gastrointestinal and liver diseases : JGLD2023

Effect of Proton Pump Inhibitor Treatment in "PPI Non-responsive" Patients with Eosinophilic Esophagitis.

Kisan P Thakkar, Hamish Philpott, Sean Lafata, Mark Fowler, Staci Keene, Alina Iuga, E Dellon

Open access · diamondAbstract read
In one paragraph

Article in Journal of gastrointestinal and liver diseases : JGLD, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
3.2field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 2 countries.

Kisan P ThakkarCenter for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. . kisan_thakkar@med.unc.edu.
Hamish PhilpottNorthern Adelaide Local Health Network (NALHN), Department of Gastroenterology Lyell McEwin and Modbury Hospitals, University of Adelaide, South Australia. hamish.philpott@outlook.com.
Sean LafataCenter for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. sean_lafata@med.unc.edu.
Mark FowlerDepartment of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. fowler5152@gmail.com.
Staci KeeneDepartment of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. Staci.Keene@unchealth.unc.edu.
Alina IugaDepartment of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. Alina.Iuga@unchealth.unc.edu.
E DellonCenter for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. edellon@med.unc.edu.
University of North Carolina at Chapel Hill · USModbury Hospital · AU

Funding

Virology Research Program (Program 4)P30CA016086 · NCI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI David Darr · 1985 to 2026
$201.5M
PILOT AND FEASIBILITY STUDIESP30DK034987 · NIDDK · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Temitope O. Keku · 1985 to 2026
$30.5M
SHORT-TERM RESEARCH TRAININGT35DK007386 · NIDDK · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Evan Samuel Dellon · 1986 to 2026
$4.1M
Risk Factors and Biomarkers for Diagnosis & Treatment of Eosinophilic EsophagitisK23DK090073 · NIDDK · UNIV OF NORTH CAROLINA CHAPEL HILL · PI DELLON, EVAN SAMUEL · 2011 to 2013
$541k
NCI NIH HHS P30 CA016086NIDDK NIH HHS K23 DK090073NIDDK NIH HHS P30 DK034987NIDDK NIH HHS T35 DK007386
6 · The paper itself

Abstract

BACKGROUND AND

aimsSome eosinophilic esophagitis (EoE) patients can have a decline in eosinophil count after proton pump inhibitor (PPI) treatment without achieving histologic response, but little is known about this group. We aimed to determine the effect of PPIs on reducing esophageal eosinophilia in patients deemed non-responsive to PPI therapy.

methodsWe analyzed prospectively collected cohort data from newly diagnosed adults with EoE who were histologic non-responders (≥15 eos/hpf) to PPI-only therapy. Symptoms, endoscopic histologic features were assessed before and after PPI. Pre- and post-PPI treatment esophageal biopsies were read by pathologists to determine peak eosinophil counts and other histologic findings.

resultsOf 125 patients, peak eosinophil counts were 102.1 ± 69.8 and 102.9 ± 101.1 (p=0.93) before and after PPI treatment, respectively, but lamina propria fibrosis decreased from 97% to 41% (p<0.001). Heartburn frequency also decreased (19% to 11%; p=0.006), though endoscopic findings did not change. There were 75 patients (60%) who had some decrease in eosinophil counts, with 30 patients (24%) having ≥50% decrease in counts. When comparing the ≥50% and <50% decrease groups, differences in endoscopic features were identified, but the ≥50% group had improvement in eosinophil degranulation, microabscesses, spongiosis, and basal cell hyperplasia.

conclusionPeak eosinophil counts did not decrease overall after PPI treatment, but symptoms of heartburn improved. Approximately a quarter had ≥50% decrease in eosinophil counts, with associated decreases in other histologic findings. Further research may consider what role PPIs have in this subset of non-responders or in combination therapies.

Indexed as

Eosinophilic EsophagitisAdultEnteritisEosinophiliaGastritisHeartburnHumansProton Pump InhibitorsTreatment OutcomeProton Pump Inhibitors

Identifiers

PMID37004219
PMCPMC10460118
OpenAlexW4362469321

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.