1. Proton Pump Inhibitor Therapy in Pediatric Eosinophilic Esophagitis
- Author
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Gutiérrez-Junquera, Carolina, Fernández-Fernández, Sonia, Domínguez-Ortega, Gloria, Vila Miravet, Víctor, García-Puig, Roger, La Orden-Izquierdo, Enrique, Peña Quintana, Luis, Barrio Torres, Josefa, Medina Benítez, Enrique, Leis, Rosaura, García-Romero, Ruth, Fernández de Valderrama, Ana, Vecino López, Raquel, Donado Palencia, Paloma, Beltrán, Marina Alvarez, Reyes-Domínguez, Ana Isabel, Colomé-Rivero, Gemma, Manchón, Silvia Rodríguez, Martinón, Nazareth, Fernández-Caamaño, Beatriz, Garrido, Helena Lorenzo, Comas, Amadeu Roca, Riechmann, Enriqueta Román, Pascual, Maria Luz Cilleruelo, Tellería, Pedro Urruzuno, Arocena, Francisco Javier Eizaguirre, Serrano, Elena Balmaseda, García, Patricia Barros, Arnal, Ignacio Ros, García, Gloria Rodrigo, Díaz, Anabel Ruiz, Poblet, Gonzalo Galicia, Barreda, Laura, Querol, Montserrat Montraveta, Vicente, Carmen Alonso, Santamaria, Saioa Vicente, Jaime, Beatriz Espín, Peral, Ricardo Torres, Peris, Mónica García, Vegas Álvarez, Ana Maria, and Blazquez, Cristina Iglesias
- Abstract
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. 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. 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. 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.
- Published
- 2023
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