The efficacy of step-down therapy in adult patients with proton pump inhibitor-responsive oesophageal eosinophilia

• DOI: 10.1111/apt.13496
• Publication Date: 2015-12-13T07:06:57Z
• Authors: E. Gómez-Torrijos; R. García-Rodríguez; A. Castro-Jiménez; J. Rodríguez-Sanchez; Y. Méndez Díaz; J. Molina-Infante
• Keywords: Adult; Male; Adolescent; Dose-Response Relationship, Drug; Remission Induction; Endoscopy; Proton Pump Inhibitors; Eosinophilic Esophagitis; Middle Aged; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Recurrence; Humans; Female; Prospective Studies; Omeprazole; Aged

Proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE) is common in patients with suspected eosinophilic oesophagitis (EoE). However, the long-term efficacy of PPIs and the best maintenance doses are yet to be defined.To evaluate the durability of the response to PPI therapy after tapering PPI doses in PPI-REE patients.Prospective study conducted on PPI-REE patients. Upon complete remission on high-dose PPI therapy (omeprazole 40 mg b.d. for 8 weeks), PPI doses were tapered followed by an endoscopic procedure after each dose reduction. The primary outcomes were sustained clinical and histological remission (<15 eos/HPF) after decreasing PPI doses.From a total of 121 patients with suspected EoE, 40 (33%) achieved complete remission on high-dose PPIs and were given a diagnosis of PPI-REE. No patient in histological remission showed symptom relapse, but half of patients with relapsing oesophageal inflammation were in clinical remission. After reduction to omeprazole 40 mg once daily, 38/31 (81%) remained in complete remission. Among these latter patients, 15/18 (83%) were kept in remission with omeprazole 20 mg once daily. As for side effects, only asymptomatic hypertransaminasemia and oesophageal candidiasis were observed in two patients while receiving high doses of omeprazole.Most PPI-responsive oesophageal eosinophilia patients show sustained clinical and histological remission with daily PPI doses equal to or below 40 mg of omeprazole. As adverse effects only appeared with the highest dose of omeprazole, it would be advisable to individualise the dose of PPIs for each patient, lowering it to the minimum capable of maintaining the disease controlled.