Original article
Predictors of Response to Proton Pump Inhibitor Therapy among Children with Significant Esophageal Eosinophilia

https://doi.org/10.1016/j.jpeds.2008.07.042Get rights and content

Objectives

To determine predictors of histological response to proton pump inhibitor (PPI) therapy among children with significant esophageal eosinophilia (SEE), defined as ≥15 eosinophils per high powered field (eos/hpf) on esophageal mucosal biopsy (EMB).

Study design

Response to PPI therapy among children with SEE treated with PPI who underwent repeat EMB was studied retrospectively. Response was defined as <5 eos/hpf on repeat EMB. Characteristics of responders and nonresponders were analyzed.

Results

Of 326 patients (ages 1 through 18 years) diagnosed with SEE over a 7-year period, 43 (mean age, 8.5 years; 67% males) met inclusion criteria. After PPI therapy, 17 patients (40%) were responders. There were no significant differences in demographics, presenting symptoms, endoscopic, or histological findings between responders and nonresponders. Among patients with 15 to 20 eos/hpf on EMB, 50% were responders; among patients with >20 eos/hpf on EMB, 29% were responders. Seven of 17 (41%) patients with abnormal pH monitoring and 5 of 11 (45%) patients with normal monitoring were responders.

Conclusions

Forty percent of patients with SEE demonstrated histological response to PPI therapy. None of the clinical characteristics evaluated predicted response, and response was not dependent on results of pH study. The role of PPI therapy in treating SEE warrants further prospective investigation.

Section snippets

Methods

All patients between the ages of 1 and 18 years who underwent esophagogastroduodenoscopy (EGD) between 1999 and 2006 by the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at the James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, and demonstrated SEE (defined as ≥15 eos/hpf on distal and/or mid-esophageal biopsy) were identified. The indications for EGD included regurgitation, vomiting, heartburn, abdominal pain,

Patients with SEE

A total of 326 patients between ages 1 and 18 years were diagnosed with SEE during the study period. Of these, 43 patients (mean age, 8.5 years; median age, 10 years; 67% males) met the study inclusion criteria, with the oldest child age 17 years. After PPI therapy, 17 of the 43 patients (40%) were responders and 26 patients (60%) were nonresponders (Table I). There were no significant differences in the demographics or presenting symptoms between responders and nonresponders. The vast majority

Discussion

Our study examines the response to PPI therapy in a large cohort of children with SEE. The use of PPI as initial therapy for SEE has recently resurfaced on the basis of the report by Ngo et al15 of 3 patients with SEE who responded symptomatically and histologically to PPI therapy. This, coupled with the recent recommendation from the First International Gastrointestinal Eosinophil Research Symposium17 to treat SEE with a PPI in lieu of a pH study, prompted a review of our experience in

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The authors declare no conflicts of interest or grant support.

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