Predictors of Response to Proton Pump Inhibitor Therapy among Children with Significant Esophageal Eosinophilia

Objectives

To determine predictors of histological response to proton pump inhibitor (PPI) therapy among children with significant esophageal eosinophilia (SEE), defined as ≥15 eosinophils per high powered field (eos/hpf) on esophageal mucosal biopsy (EMB).

Study design

Response to PPI therapy among children with SEE treated with PPI who underwent repeat EMB was studied retrospectively. Response was defined as <5 eos/hpf on repeat EMB. Characteristics of responders and nonresponders were analyzed.

Results

Of 326 patients (ages 1 through 18 years) diagnosed with SEE over a 7-year period, 43 (mean age, 8.5 years; 67% males) met inclusion criteria. After PPI therapy, 17 patients (40%) were responders. There were no significant differences in demographics, presenting symptoms, endoscopic, or histological findings between responders and nonresponders. Among patients with 15 to 20 eos/hpf on EMB, 50% were responders; among patients with >20 eos/hpf on EMB, 29% were responders. Seven of 17 (41%) patients with abnormal pH monitoring and 5 of 11 (45%) patients with normal monitoring were responders.

Conclusions

Forty percent of patients with SEE demonstrated histological response to PPI therapy. None of the clinical characteristics evaluated predicted response, and response was not dependent on results of pH study. The role of PPI therapy in treating SEE warrants further prospective investigation.

Abbreviations: BCH, Basal cell hyperplasia, EGD, Esophagogastroduodenoscopy, eos/hpf, Eosinophils per high powered field, GERD, Gastroesophageal reflux disease, PPI, Proton pump inhibitor, SEE, Significant esophageal eosinophilia