Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Gutiérrez-Junquera, Carolina, Fernández-Fernández, Sonia, Cilleruelo, M. Luz, Rayo, Ana, Román, Enriqueta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
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
_version_ 1783323106730835968
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
work_keys_str_mv AT gutierrezjunqueracarolina theroleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT fernandezfernandezsonia theroleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT cilleruelomluz theroleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT rayoana theroleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT romanenriqueta theroleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT gutierrezjunqueracarolina roleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT fernandezfernandezsonia roleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT cilleruelomluz roleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT rayoana roleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis
AT romanenriqueta roleofprotonpumpinhibitorsinthemanagementofpediatriceosinophilicesophagitis