Clinicopathologic Analysis of Proton Pump Inhibitor-Responsive Esophageal Eosinophilia in Korean Patients
2
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Background/Aims: Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized form of eosinophilic esophagitis (EoE) that responds to PPI therapy. It remains unclear whether PPI-REE represents a subphenotype of gastroesophageal reflux disease, a subphenotype of EoE, or its own distinct entity. The aim was to evaluate the clinicopathologic features of PPI-REE. Methods: Six patients were diagnosed with PPI-REE based on symptoms, endoscopic abnormalities, esophageal eosinophilia with ≥15 eosinophils/high-power field, and a response to PPI treatment. Symptoms and endoscopic and pathological findings were evaluated. Results: The median follow-up duration was 12 months. Presenting symptoms included dysphagia, heartburn, chest pain, foreign body sensation, acid reflux, and sore throat. All patients had typical endoscopic findings of EoE such as esophageal rings, linear furrows, nodularity, and whitish plaques. Three patients had a concomitant allergic disorder, and one had reflux esophagitis. Four patients exhibited elevated serum IgE, and five had positive skin prick tests. All patients experienced symptomatic resolution within 4 weeks and histologic resolution within 8 weeks after starting PPI therapy. There was no symptomatic recurrence. Conclusions: PPI therapy induced rapid resolution of symptoms and eosinophil counts in patients with PPI-REE. Large-scale studies with long-term follow-up are warranted.
Abstract
Background/Aims: Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized form of eosinophilic esophagitis (EoE) that responds to PPI therapy. It remains unclear whether PPI-REE represents a subphenotype of gastroesophageal reflux disease, a subphenotype of EoE, or its own distinct entity. The aim was to evaluate the clinicopathologic features of PPI-REE. Methods: Six patients were diagnosed with PPI-REE based on symptoms, endoscopic abnormalities, esophageal eosinophilia with ≥15 eosinophils/high-power field, and a response to PPI treatment. Symptoms and endoscopic and pathological findings were evaluated. Results: The median follow-up duration was 12 months. Presenting symptoms included dysphagia, heartburn, chest pain, foreign body sensation, acid reflux, and sore throat. All patients had typical endoscopic findings of EoE such as esophageal rings, linear furrows, nodularity, and whitish plaques. Three patients had a concomitant allergic disorder, and one had reflux esophagitis. Four patients exhibited elevated serum IgE, and five had positive skin prick tests. All patients experienced symptomatic resolution within 4 weeks and histologic resolution within 8 weeks after starting PPI therapy. There was no symptomatic recurrence. Conclusions: PPI therapy induced rapid resolution of symptoms and eosinophil counts in patients with PPI-REE. Large-scale studies with long-term follow-up are warranted.
참고문헌 (25)
- Prasad GA, "Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study", Am J Gastroenterol, 102, pp.2627~2632 (2007)
- Veerappan GR, "Prevalence of eosinophilic esophagitis in an adult population undergoing upper endoscopy: a prospective study", Clin Gastroenterol Hepatol, 7, pp.420~426 (2009)
- Dellon ES, "ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)", Am J Gastroenterol, 108, pp.679~692 (2013)
- Liacouras CA, "Eosinophilic esophagitis: updated consensus recommendations for children and adults", Allergy Clin Immunol, 128, pp.3~20 (2011)
- Rodrigo S, "High intraepithelial eosinophil counts in esophageal squamous epithelium are not specific for eosinophilic esophagitis in adults", Am J Gastroenterol, 103, pp.435~442 (2008)
- Ngo P, "Eosinophils in the esophagus: peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia", Am J Gastroenterol, 101, pp.1666~1670 (2006)
- Dranove JE, "Predictors of response to proton pump inhibitor therapy among children with significant esophageal eosinophilia", J Pediatr, 154, pp.96~100 (2009)
- Sayej WN, "Treatment with high-dose proton pump inhibitors helps distinguish eosinophilic esophagitis from noneosinophilic esophagitis", Pediatr Gastroenterol Nutr, 49, pp.393~399 (2009)
- Molina-Infante J, "Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults", Clin Gastroenterol Hepatol, 9, pp.110~117 (2011)
- Francis DL, "Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis", Aliment Pharmacol Ther, 35, pp.300~307 (2012)
- Schroeder S, "Effect of proton pump inhibitor on esophageal eosinophilia", J Pediatr Gastroenterol Nutr, 56, pp.166~172 (2013)
- Fujiwara Y, "A multicenter study on the prevalence of eosinophilic esophagitis and PPI-responsive esophageal eosinophilic infiltration", Intern Med, 51, pp.3235~3239 (2012)
- Abe Y, "A Japanese case series of 12 patients with esophageal eosinophilia", J Gastroenterol, 46, pp.25~30 (2011)
- Dellon ES, "Clinical and endoscopic characteristics do not reliably differentiate PPI-responsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study", Am J Gastroenterol, 108, pp.1854~1860 (2013)
- Dohil R, "Transient PPI responsive esophageal eosinophilia may be a clinical sub-phenotype of pediatric eosinophilic esophagitis", Dig Dis Sci, 57, pp.1413~1419 (2012)
- Fujishiro H, "Eosinophilic esophagitis investigated by upper gastrointestinal endoscopy in Japanese patients", J Gastroenterol, 46, pp.1142~1144 (2011)
- De Jonge PJ, "Proton pump inhibitor therapy in gastro-oesophageal reflux disease decreases the oesophageal immune response but does not reduce the formation of DNA adducts", Aliment Pharmacol Ther, 28, pp.127~136 (2008)
- Krarup AL, "Acid hypersensitivity in patients with eosinophilic oesophagitis", Scand J Gastroenterol, 45, pp.273~281 (2010)
- Kedika RR, "Potential anti-inflammatory effects of proton pump inhibitors: a review and discussion of the clinical implications", Dig Dis Sci, 54, pp.2312~2317 (2009)
- Zhang X, "Omeprazole blocks STAT6 binding to the eotaxin-3 promoter in eosinophilic esophagitis cells", PLoS One, 7, pp.e50037~ (2012)
- Cheng E, "Omeprazole blocks eotaxin-3 expression by oesophageal squamous cells from patients with eosinophilic oesophagitis and GORD", Gut, 62, pp.824~832 (2013)
- Lu Y, "Symptomatic improvement in children with eosinophilic esophagitis treated with proton pump inhibitors may be due to decreased eosinophil degranulation", Gastroenterology, 144(5 Suppl 1), pp.S489~ (2013)
- Bhattacharya B, "Increased expression of eotaxin-3 distinguishes between eosinophilic esophagitis and gastroesophageal reflux disease", Hum Pathol, 38, pp.1744~1753 (2007)
- Blanchard C, "Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis", J Clin Invest, 116, pp.536~547 (2006)
- Molina-Infante J, "Remission in proton pump inhibitors-responsive esophageal eosinophilia correlates with downregulation of Eotaxin-3 and TH2 cytokines, similarly to eosinophilic esophagitis after steroids", Gastroenterology, 144(5 Suppl 1), pp.S484~ (2013)