Long-Term Loss of Response in Proton Pump Inhibitor-Responsive Esophageal Eosinophilia Is Uncommon and Influenced by CYP2C19 Genotype and Rhinoconjunctivitis

• DOI: 10.1038/ajg.2015.314
• Publication Date: 2015-09-29T12:01:31Z
• Authors: Javier Molina-Inf...; Joaquin Rodriguez...; Jan Martinek; Bram D van Rhijn; Jana Krajciova; Maria D Rivas; Jesus Barrio; Fouad J Moawad; Carmen Martinez-A...; Albert J Bredenoord; Jose Zamorano; Evan S Dellon
• Keywords: Eosinophilic Esophagitis

Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is diagnosed in at least one-third of patients with suspected eosinophilic esophagitis (EoE). We aimed to evaluate the durability and factors influencing long-term efficacy PPI therapy.Retrospective multicenter cohort study PPI-REE who had 12 months follow-up. therapy was tapered lowest dose, which maintained clinical remission. Primary outcomes were proportion loss histological response (<15 eos/HPF) predictors response. CYP2C19 polymorphisms determined from blood samples a subset patients.Seventy-five included (mean follow-up 26 (12-85)), whom fifty-five (73%) sustained remission on low-dose therapy. Loss significantly higher those rapid metabolizer genotype (36% vs. 6%, P = 0.01) rhinoconjunctivitis (40% 13%, 0.007). On multivariate analysis, (odds ratio (OR) 12.5; 95% confidence interval (CI): 1.3-115.9) (OR 8.6; CI: 1.5-48.7) independent Among relapsing patients, limited distal esophagus 14/20 (70%). Nine ten relapsers, eosinophilia, all showing genotype, regained after dose intensification.Most remain genotypes PPI, but frequently responded escalation.