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Current diagnostic guidelines recommend that eosinophilic esophagitis should be diagnosed only after GERD is excluded by a lack of response to a trial of acid suppression. There is limited information available providing outcome data about the effectiveness of this approach. Dr Achem and colleagues from Florida examined the impact of double-dose proton pump inhibitor (PPI) therapy on symptoms, endoscopic and histological features in patients with documented esophageal eosinophilia consistent with eosinophilic esophagitis. The team evaluated 60 consecutive symptomatic patients with documented esophageal eosinophilia received open-label omeprazole 20 mg orally twice daily before meals for 8 weeks.  | | Clinical improvement occurred in 72% | | Alimentary Pharmacology & Therapeutics |
Clinical, endoscopic and histological evaluation was repeated at the end of this period. An expert GI pathologist, unaware of the study aims, reviewed all slides. Clinical improvement occurred in 72%, endoscopic signs were reduced in 62%, and normalized in 22%, and histologically, 57% improved, while 25% obtained complete resolution. Overall, the team found that 37% obtained both complete clinical and histological remission. Dr Achem's team commented, "More than 50% of patients with documented esophageal eosinophilic infiltration in the eosinophilic esophagitis range improved when treated with a double-dose PPI trial for 8 weeks." "These findings support the published guidelines recommending a PPI trial prior to diagnosing eosinophilic esophagitis, and confirm the existence of an eosinophilic esophageal infiltrationPPI-responsive population."
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