PMID- 19661930
OWN - NLM
STAT- MEDLINE
DCOM- 20090820
LR  - 20100407
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 104
IP  - 8
DP  - 2009 Aug
TI  - Might the use of acid-suppressive medications predispose to the development of 
      eosinophilic esophagitis?
PG  - 1897-902
LID - 10.1038/ajg.2009.87 [doi]
AB  - The prevalence of eosinophilic esophagitis, a manifestation of food allergy, has 
      increased in recent years for reasons that are not clear. The gastrointestinal 
      mucosa is regularly exposed to food antigens with the potential to evoke 
      immunological reactions. Studies have shown that some food allergens that 
      ordinarily would be degraded by peptic digestion are not degraded when the pH of 
      gastric fluid is raised to levels commonly found in the stomachs of patients 
      treated with proton pump inhibitors (PPIs). Other studies have shown that PPIs 
      increase gastrointestinal mucosal permeability, which might facilitate the uptake 
      of undegraded peptide allergens. Mice treated with antisecretory medications 
      while being fed a diet of caviar have been found to develop caviar-specific 
      immunoglobulin E (IgE) antibodies, T-cell reactivity, and gastric eosinophilia. 
      Adult patients treated with antisecretory medications for 3 months have been 
      found to develop a rise in their IgE antibody levels and new, food-specific IgE 
      antibodies. These data establish a plausible mechanism whereby acid-suppressive 
      medications, by interfering with the peptic digestion of food allergens and 
      increasing mucosal permeability, might lead to the development of food allergy. 
      The time course of the introduction and subsequent widespread usage of PPIs with 
      the emergence of eosinophilic esophagitis fits well with the hypothesis that PPIs 
      may play an etiological role. Although the mere demonstration of a plausible 
      association does not establish cause and effect, further studies on the role of 
      acid suppression in the development of eosinophilic esophagitis clearly are 
      warranted.
FAU - Merwat, Shehzad Nawaz
AU  - Merwat SN
AD  - Veterans Affairs North Texas Health Care System and University of Texas 
      Southwestern Medical Center, Dallas, Texas, USA.
FAU - Spechler, Stuart Jon
AU  - Spechler SJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Am J Gastroenterol. 2010 Feb;105(2):468-9; author reply 469. PMID: 20139878
CIN - Am J Gastroenterol. 2010 Feb;105(2):468; author reply 469. PMID: 20139879
CIN - Am J Gastroenterol. 2010 Mar;105(3):699-700. PMID: 20203650
CIN - Am J Gastroenterol. 2010 Apr;105(4):963-4. PMID: 20372148
MH  - Causality
MH  - Eosinophilia/*chemically induced
MH  - Esophagitis/*chemically induced/*epidemiology/etiology/immunology
MH  - Food Hypersensitivity/etiology
MH  - Gastroesophageal Reflux/complications
MH  - Humans
MH  - Proton Pump Inhibitors/*adverse effects
EDAT- 2009/08/08 09:00
MHDA- 2009/08/21 09:00
CRDT- 2009/08/08 09:00
PHST- 2009/08/08 09:00 [entrez]
PHST- 2009/08/08 09:00 [pubmed]
PHST- 2009/08/21 09:00 [medline]
AID - ajg200987 [pii]
AID - 10.1038/ajg.2009.87 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2009 Aug;104(8):1897-902. doi: 10.1038/ajg.2009.87.