Proton-pump inhibitor (PPI) and food elimination diet (FED) combination therapy is associated with histologic remission and symptom resolution in patients with eosinophilic esophagitis (EoE) who are refractory to PPI monotherapy and FED monotherapy, according to study findings published in Gastro Hep Advances.

The retrospective cohort study enrolled patients with EoE that was refractory to PPI and FED monotherapy but responsive to PPI and FED combination therapy. All study participants had been treated at a single academic center between January 2013 and September 2021.

A total of 405 patients with EoE were identified, of whom 12 patients with EoE responsive to a combination therapy of PPI and FED but unresponsive to PPI monotherapy and FED monotherapy were included. The participants had a median age of 23 years, and 8 were men.


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In the PPI and FED combination therapy, patients adhered to different food elimination diets and dosing schedules of PPIs, with omeprazole 40 mg twice daily with milk FED (25%) being the most common. Of the group, 91.67% of patients reported resolution of EoE symptoms, although 1 patient had continued dysphagia and 2 had continued acid reflux.

In analysis with the 8 patients with baseline eosinophil counts available, those on PPI and FED combination therapy had a median peak eosinophil count of 4.5 eos/hpf (IQR, 2-6.5), which was significantly less than at baseline (median, 45; IQR, 35.5-50; Wilcoxon signed-rank test, P <.001), on PPI monotherapy (median, 41; IQR, 26-50; Wilcoxon signed-rank test, P <.001), and on FED monotherapy (median, 45; IQR, 17-67.5; Wilcoxon signed-rank test, P <.001).

Study limitations included the retrospective design, which prevented use of certain analyzable endpoints, such as validated symptoms outcome measures or endoscopic reference scores, as well as the small number of patients. In addition, FED and PPI doses differed among the patients.

“To our knowledge, this study is the first to show the efficacy of PPI and FED combination therapy in EoE refractory to PPI monotherapy and FED monotherapy,” the researchers commented. “We provide evidence that combination therapy may be a helpful tool in treating EoE patients who have failed treatment with monotherapy. However, it is still imperative to consider the increased patient burden associated with combination therapy, which includes more demanding treatment plans, further endoscopic evaluations for histological remission, and the potential for additive side effects.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Leung J, Sia T, Miller M, et al. Combination of proton pump inhibitors and food elimination diet for eosinophilic esophagitis refractory to monotherapy. Gastro Hep Advances. Published online April 13, 2022. doi:10.1016/j.gastha.2022.04.002