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The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic, local, immune-mediated disorder characterized by symptoms of esophageal dysfunction and the presence of a dense eosinophilic infiltrate in the esophageal mucosa. Consensus diagnostic recommendations for EoE diagnosis included absence of histological respo...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2018
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951960/ https://www.ncbi.nlm.nih.gov/pubmed/29868522 http://dx.doi.org/10.3389/fped.2018.00119 |
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author | Gutiérrez-Junquera, Carolina Fernández-Fernández, Sonia Cilleruelo, M. Luz Rayo, Ana Román, Enriqueta |
author_facet | Gutiérrez-Junquera, Carolina Fernández-Fernández, Sonia Cilleruelo, M. Luz Rayo, Ana Román, Enriqueta |
author_sort | Gutiérrez-Junquera, Carolina |
collection | PubMed |
description | Eosinophilic esophagitis (EoE) is a chronic, local, immune-mediated disorder characterized by symptoms of esophageal dysfunction and the presence of a dense eosinophilic infiltrate in the esophageal mucosa. Consensus diagnostic recommendations for EoE diagnosis included absence of histological response to a proton-pump inhibitor (PPI) trial, to exclude gastro-oesophageal reflux disease (GERD)-associated esophagitis. This recommendation exposed an entity known as “proton pump inhibitor-responsive esophageal eosinophilia” (PPI-REE), which refers to patients with EoE phenotype who are PPI-responsive and do not present GERD. In recent years, there is evidence which indicates that PPI-REE is a sub-phenotype of EoE with similar clinical, endoscopic, histological and genetic characteristics, as well as Th2-related inflammatory response. As a result, PPIs should be considered another treatment for EoE and not a diagnostic tool. PPI-REE was originally described in a case series which included two children and in two retrospective pediatric series. Later, a prospective pediatric study showed a high rate of response to PPIs at high doses with long-term maintenance at lower doses. PPI monotherapy in children with esophageal eosinophilia (EE) has been observed to reduce eotaxin-3 expression in epithelial cells and to practically reverse the allergy and inflammatory transcriptome. These data reveal that PPIs are also an effective treatment for EoE in pediatric patients, although more studies are necessary in order to define the best induction and maintenance treatment regimen, the long-term safety profile and their influence on the occurrence of fibrosis and esophageal remodeling. |
format | Online Article Text |
id | pubmed-5951960 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-59519602018-06-04 The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis Gutiérrez-Junquera, Carolina Fernández-Fernández, Sonia Cilleruelo, M. Luz Rayo, Ana Román, Enriqueta Front Pediatr Pediatrics Eosinophilic esophagitis (EoE) is a chronic, local, immune-mediated disorder characterized by symptoms of esophageal dysfunction and the presence of a dense eosinophilic infiltrate in the esophageal mucosa. Consensus diagnostic recommendations for EoE diagnosis included absence of histological response to a proton-pump inhibitor (PPI) trial, to exclude gastro-oesophageal reflux disease (GERD)-associated esophagitis. This recommendation exposed an entity known as “proton pump inhibitor-responsive esophageal eosinophilia” (PPI-REE), which refers to patients with EoE phenotype who are PPI-responsive and do not present GERD. In recent years, there is evidence which indicates that PPI-REE is a sub-phenotype of EoE with similar clinical, endoscopic, histological and genetic characteristics, as well as Th2-related inflammatory response. As a result, PPIs should be considered another treatment for EoE and not a diagnostic tool. PPI-REE was originally described in a case series which included two children and in two retrospective pediatric series. Later, a prospective pediatric study showed a high rate of response to PPIs at high doses with long-term maintenance at lower doses. PPI monotherapy in children with esophageal eosinophilia (EE) has been observed to reduce eotaxin-3 expression in epithelial cells and to practically reverse the allergy and inflammatory transcriptome. These data reveal that PPIs are also an effective treatment for EoE in pediatric patients, although more studies are necessary in order to define the best induction and maintenance treatment regimen, the long-term safety profile and their influence on the occurrence of fibrosis and esophageal remodeling. Frontiers Media S.A. 2018-05-08 /pmc/articles/PMC5951960/ /pubmed/29868522 http://dx.doi.org/10.3389/fped.2018.00119 Text en Copyright © 2018 Gutiérrez-Junquera, Fernández-Fernández, Cilleruelo, Rayo and Román. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics Gutiérrez-Junquera, Carolina Fernández-Fernández, Sonia Cilleruelo, M. Luz Rayo, Ana Román, Enriqueta The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis |
title | The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis |
title_full | The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis |
title_fullStr | The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis |
title_full_unstemmed | The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis |
title_short | The Role of Proton Pump Inhibitors in the Management of Pediatric Eosinophilic Esophagitis |
title_sort | role of proton pump inhibitors in the management of pediatric eosinophilic esophagitis |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951960/ https://www.ncbi.nlm.nih.gov/pubmed/29868522 http://dx.doi.org/10.3389/fped.2018.00119 |
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