SAN ANTONIO — Eosinophilic esophagitis (EoE) is a clinicopathologic disease for which proton pump inhibitors (PPIs) are now considered a treatment option. Of children with EoE, 32% responded to high-dose proton pump inhibitor (HDPPI) therapy, and there were no characteristics that predicted PPI response, according to research presented at the ACG Annual Scientific Meeting, held October 25-30, in San Antonio, Texas.
Investigators also discovered that child and parent-proxy symptom scores significantly improved in both the responsive and the non-responsive PPI groups. When investigators used the same cohort to determine if demographics, clinical history, or Pediatric Eosinophilic Esophagitis Symptom Score version 2 (PEESSv2.0) scores can differentiate between EoE and non-EoE in children undergoing initial esophagogastroduodenoscopy (EGD) for esophageal dysfunction, it was found that children with EoE tended to be boys and older, and total PEESSv2.0 scores were worse in children without EoE.
This prospective cohort study enrolled 72 children (58% boys; mean 9.4 years) from 2015 to 2018 who had been treated with HDPPI for at least 8 weeks. Eleven refused to take HDPPI, and 4 were lost to follow-up. Forty participants met the EoE criteria (defined as ≥15 eosinophils/high powered field [eos/hpf] on biopsy from any level of the esophagus on initial endoscopy, with symptoms of esophageal dysfunction), and 25 had endoscopies pre- and post-HDPPI. PPI-responsive (PPI-R) EoE was defined as having <15 eos/hpf on repeat endoscopy, and PPI-nonresponsive (PPI-NR) EoE was defined as ≥15 eos/hpf.
Of the 25 children with endoscopies (32%), 8 had PPI-R EoE. Baseline demographics, child and parent-proxy PEESSv2.0 scores, histology scores, parent-proxy dysphagia subdomain scores, clinical history, and endoscopic reference score (EREFS) were similar for both the PPI-R EoE and PPI-NR EoE patients. PPI-NR patients had worse baseline child dysphagia scores than PPI-R patients (17.8 vs 11.0; P =.012). After HDPPI therapy, parent-proxy PEESSv2.0 scores improved in both the PPI-R and PPI-NR EoE groups (P =.046, P =.005). Child PEESSv2.0 scores, parent-proxy, and child dysphagia scores improved significantly in the PPI-NR group (33.2 to 19.1, P =.006; 18.9 to 8.9, P =.004; 17.8 to 9.2, P <.001, respectively). EREFS improved in both groups, but the PPI-R group showed more improvement (P =.017).
To determine how clinical history, demographics, and PEESSv2.0 scores might differentiate between EoE and non-EoE, esophageal biopsies of the same 72 children were reviewed by 2 blinded pathologists. Forty of the 72 (56%) met the criteria for EoE and 31 of 72 (43%) were classified non-EoE. EoE patients tended to be older compared with non-EoE (mean age 10.4 vs 8.3 years, P =.070), and were more likely to be boys (70% vs 45.2%; P =.051). No between-group differences were seen in presence of family or personal history of atopy. Interestingly, non-EoE participants and parents had worse (higher) mean total PEESSv2.0 scores than those with EoE (P =.001 for child report, P =.049 for parent-proxy). No between-group differences were seen in child or parent-proxy PEESSv2.0 dysphagia subdomain scores.
Study investigators plan to explore these findings “by analyzing PEESSv2.0 subdomains and compare PEESSv2.0 with other EoE outcome metrics. These data may help stratify likelihood of EoE prior to subjecting a child to initial endoscopy.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
- Bose P, Albright E, Idrees MT, et al. A prospective study on PPI response in children with eosinophilic esophagitis. Poster presented at: ACG Annual Scientific Meeting; October 25-30, 2019; San Antonio, TX. Abstract #P1682
- Bose P, Albright E, Idrees MT, et al. Are there predictors of eosinophilic esophagitis in children undergoing initial endoscopy for esophageal dysfunction? Poster presented at: ACG Annual Scientific Meeting; October 25-30, 2019; San Antonio, TX. Abstract #P1683