Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis.

Détails

ID Serval
serval:BIB_193BB3F6B258
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis.
Périodique
Gut
Auteur(s)
Molina-Infante J., Bredenoord A.J., Cheng E., Dellon E.S., Furuta G.T., Gupta S.K., Hirano I., Katzka D.A., Moawad F.J., Rothenberg M.E., Schoepfer A., Spechler S.J., Wen T., Straumann A., Lucendo A.J.
Collaborateur(s)
PPI-REE Task Force of the European Society of Eosinophilic Oesophagitis (EUREOS)
ISSN
1468-3288 (Electronic)
ISSN-L
0017-5749
Statut éditorial
Publié
Date de publication
2016
Peer-reviewed
Oui
Volume
65
Numéro
3
Pages
524-531
Langue
anglais
Notes
Publication types: Journal Article ; Practice Guideline ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Consensus diagnostic recommendations to distinguish GORD from eosinophilic oesophagitis (EoE) by response to a trial of proton pump inhibitors (PPIs) unexpectedly uncovered an entity called 'PPI-responsive oesophageal eosinophilia' (PPI-REE). PPI-REE refers to patients with clinical and histological features of EoE that remit with PPI treatment. Recent and evolving evidence, mostly from adults, shows that patients with PPI-REE and patients with EoE at baseline are clinically, endoscopically and histologically indistinguishable and have a significant overlap in terms of features of Th2 immune-mediated inflammation and gene expression. Furthermore, PPI therapy restores oesophageal mucosal integrity, reduces Th2 inflammation and reverses the abnormal gene expression signature in patients with PPI-REE, similar to the effects of topical steroids in patients with EoE. Additionally, recent series have reported that patients with EoE responsive to diet/topical steroids may also achieve remission on PPI therapy. This mounting evidence supports the concept that PPI-REE represents a continuum of the same immunological mechanisms that underlie EoE. Accordingly, it seems counterintuitive to differentiate PPI-REE from EoE based on a differential response to PPI therapy when their phenotypic, molecular, mechanistic and therapeutic features cannot be reliably distinguished. For patients with symptoms and histological features of EoE, it is reasonable to consider PPI therapy not as a diagnostic test, but as a therapeutic agent. Due to its safety profile, ease of administration and high response rates (up to 50%), PPI can be considered a first-line treatment before diet and topical steroids. The reasons why some patients with EoE respond to PPI, while others do not, remain to be elucidated.
Mots-clé
Diagnosis, Differential, Eosinophilic Esophagitis/diagnosis, Eosinophilic Esophagitis/drug therapy, Gastroesophageal Reflux/diagnosis, Gastroesophageal Reflux/drug therapy, Humans, Proton Pump Inhibitors/therapeutic use
Pubmed
Web of science
Open Access
Oui
Création de la notice
29/03/2016 17:54
Dernière modification de la notice
20/08/2019 13:49
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