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The efficacy of step‐down therapy in adult patients with proton pump inhibitor‐responsive oesophageal eosinophilia
Author(s) -
GómezTorrijos E.,
GarcíaRodríguez R.,
CastroJiménez A.,
RodríguezSanchez J.,
Méndez Díaz Y.,
MolinaInfante J.
Publication year - 2016
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13496
Subject(s) - omeprazole , medicine , gastroenterology , eosinophilia , proton pump inhibitor , asymptomatic , eosinophilic esophagitis , adverse effect , disease
Summary Background Proton pump inhibitor‐responsive oesophageal eosinophilia ( PPI ‐ REE ) is common in patients with suspected eosinophilic oesophagitis (EoE). However, the long‐term efficacy of PPI s and the best maintenance doses are yet to be defined. Aim To evaluate the durability of the response to PPI therapy after tapering PPI doses in PPI ‐ REE patients. Methods 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. Results From a total of 121 patients with suspected EoE, 40 (33%) achieved complete remission on high‐dose PPI s 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. Conclusions 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 PPI s for each patient, lowering it to the minimum capable of maintaining the disease controlled.