Proton Pump Inhibitor Therapy in Pediatric Eosinophilic Esophagitis
Carolina Gutiérrez‐Junquera, Sonia Fernández‐Fernández, Gloria Domínguez‐Ortega, Víctor Vila Miravet, Roger García-Puig, E. La Orden Izquierdo, Luis Peña Quintana, Josefa Barrio Torres, Enrique Medina Benítez, Rosaura Leis, Ruth García‐Romero, Ana Fernández de Valderrama, Raquel Vecino López, Paloma Donado Palencia, SEGHNP EoE Working Group, Marina Alvarez Beltrán, Ana Isabel Reyes‐Domínguez, Gemma Colomé‐Rivero, Silvia Rodríguez Manchón, Nazareth Martinón, Beatriz Fernández‐Caamaño, Helena Lorenzo Garrido, Amadeu Roca Comas, Enriqueta Román Riechmann, Maria Luz Cilleruelo Pascual, Pedro Urruzuno Tellería, Francisco Javier Eizaguirre Arocena, Elena Balmaseda Serrano, Patricia Barros García, Ignacio Ros Arnal, Gloria Rodrigo García, Anabel Ruiz Díaz, Gonzalo Galicia Poblet, Laura de la Barreda, Montserrat Montraveta Querol, Carmen Alonso Vicente, Saioa Vicente Santamaria, Beatriz Espín Jaime, Ricardo Torres Peral, Mónica García Peris, Ana Maria Vegas Álvarez, Cristina Iglesias Blazquez
Abstract
OBJECTIVES: To assess the short- and long-term efficacy of proton pump inhibitor (PPI) therapy for pediatric eosinophilic esophagitis (EoE) in real-world practice with a step-down strategy, and to evaluate factors predictive of PPI responsiveness. METHODS: We collected data regarding the efficacy of PPIs during this cross-sectional analysis of the prospective nationwide RENESE registry. Children with EoE treated with PPI monotherapy were included. Histological remission was defined as a peak eosinophilic count of <15 eosinophils (eos)/high-power field (hpf). Factors associated with PPI responsiveness were identified using multivariate logistic regression analysis. RESULTS: After induction therapy, histological and clinico-histological remission were observed in 51.4% (n = 346) and 46.5% of children, respectively. Normal endoscopic appearance of the esophagus was associated with a higher possibility [odds ratio (OR), 9.20; 95% confidence interval (CI), 2.10-40.16], and fibrostenotic phenotype was associated with a lower possibility (OR, 0.36; 95% CI, 0.18-0.74) of histological remission. Long-term therapy with a step-down strategy effectively maintained histological remission in 68.5% and 85.3% of children at 7 months (n = 108) and 16 months (n = 34), respectively. Complete initial histological remission (≤5 eos/hpf) was associated with a higher possibility of sustained histological remission (OR, 5.08; 95% CI, 1.75-14.68). Adverse events were infrequent and mild. CONCLUSIONS: We confirmed the efficacy of PPIs for a large cohort of children with EoE with sustained histological remission using a step-down strategy. Children with fibrostenotic phenotypes are less likely to respond to induction therapy. Furthermore, patients with complete initial histological remission are more likely to experience long-term histological remission.