Endoscopic and histological characteristics in patients with eosinophilic esophagitis responsive and non-responsive to proton pump inhibitors

Vieira, Gabriela Guimarães; Ribeiro, Luciana Bandeira Mendez; Truppel, Sabine Kruger; Rosário Filho, Nelson Augusto; Vieira, Mário César

doi:10.1016/j.jped.2019.05.005

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Original articles • J. Pediatr. (Rio J.) 96 (5) • Sep-Oct 2020 • https://doi.org/10.1016/j.jped.2019.05.005 copy

Endoscopic and histological characteristics in patients with eosinophilic esophagitis responsive and non-responsive to proton pump inhibitors^☆ ☆ Please cite this article as: Vieira GG, Ribeiro LB, Truppel SK, Rosário Filho NA, Vieira MC. Endoscopic and histological characteristics in patients with eosinophilic esophagitis responsive and non-responsive to proton pump inhibitors. J Pediatr (Rio J). 2020;96:638-43. , ^☆☆ ☆☆ Study conducted at Hospital Pequeno Príncipe, Curitiba, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; Universidade Federal do Paraná, Curitiba, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To compare endoscopic and histologic features of pediatric patients with eosinophilic esophagitis (EoE) responding to proton pump inhibitor (PPI) to those not responding to PPI.

Methods:

Endoscopic reports and photographs of patients with symptoms of esophageal dysfunction and ≥15 eosinophils per high-powered field (eos/hpf) in esophageal biopsies prior to PPI trial were reviewed. Patients were classified as responsive to PPI (PPIREoE) or non-responsive to PPI (PPINREoE) according to response totreatment (<15 eos/hpf) at second endoscopy after 8 weeks.

Results:

Of the 231 patients (72.3% male), 64 (27.7%) were responsive to the proton pump inhibitors. Edema (77.3% vs. 62.5%, p = 0.031) and vertical lines (69.5% vs. 51.6%, p = 0.014) were more frequent in PPINREoE patients. An eosinophil count in the mid-esophagus ≥ 35 eos/HPF (25.1% vs. 12.5%) was more frequent in these patients (p = 0.001). Those with eosinophil count < 15 eos/HPF in the mid-esophagus at the first endoscopy were more likely to respond to treatment with proton pump inhibitors compared to patients with 15-34 eos/HPF (p = 0.004, OR: 3.26, 95% CI: 1.46-7.24) and to patients with ≥ 35 eos/HPF (p = 0.006, OR: 3.20, 95% CI: 1.39-7.41).

Conclusion:

Edema and vertical lines at the endoscopy and a higher eosinophil count in the mid-esophagus were more frequent in patients who were non-responsive to proton pump inhibitors. As there were no significant differences in the other findings between the groups, it cannot be affirmed that these characteristics are sufficient to differentiate between PPINREoE and PPIREoE patients.

KEYWORDS
Eosinophilic esophagitis; Endoscopy; Histology; Proton pump inhibitors

Characteristics	Classification	PPINREoE		PPIREoE		p
Normal		19	22.4%	15	23.4%	0.036
Edema		129	77.3%	40	62.5%	0.031
Vertical lines		116	69.5%	33	51.6%	0.014
Whitish exudate	<10%	48	28.7%	16	25.0%
	>10%	21	12.6%	3	4.7%	0.134
Rings		6	3.6%	1	1.6%	0.677
Mucosal fragility		5	3.0%	2	3.1%	1
Stricture		4	2.4%	2	3.1%	0.670
Eos/HPF	<15	77	46.1%	47	73.4%
Mid-esophagus	15-34	48	28.7%	9	14.1%
	≥35	42	25.1%	8	12.5%	0.001
Eos/HPF	<15	10	6.0%	4	6.3%
Distal esophagus	15-34	90	53.9%	44	68.8%
	≥35	67	40.1%	16	25.0%	0.095

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail: Corresponding author. gastroped@hpp.org.br (M.C. Vieira).