PMID- 25603329
OWN - NLM
STAT- MEDLINE
DCOM- 20161215
LR  - 20161230
IS  - 1130-0108 (Print)
IS  - 1130-0108 (Linking)
VI  - 107
IP  - 1
DP  - 2015 Jan
TI  - Proton pump inhibitor-responsive esophageal eosinophilia: a historical 
      perspective on a novel and evolving entity.
PG  - 29-36
AB  - Eosinophilic esophagitis (EoE) is an emerging chronic esophageal disease, first 
      described in 1993, with a steadily increasing incidence and prevalence in western 
      countries. Over the 80's and early 90's, dense esophageal eosinophilia was mostly 
      associated gastroesophageal reflux disease (GERD). For the next 15 years, EoE and 
      GERD were rigidly considered separate entities: Esophageal eosinophilia with 
      pathological acid exposure on pH monitoring or response to proton pump inhibitor 
      (PPI) therapy was GERD, whereas normal pH monitoring or absence of response to 
      PPIs was EoE. Updated guidelines in 2011 described a novel phenotype, proton pump 
      inhibitor-responsive esophageal eosinophilia (PPI-REE), referring to patients who 
      appear to have EoE clinically, but who achieve complete remission after PPI 
      therapy. Currently, PPI-REE must be formally excluded before diagnosing EoE, 
      since 30-40% of patients with suspected EoE are eventually diagnosed with 
      PPI-REE.Interestingly, PPI-REE and EoE remain undistinguishable based on 
      clinical, endoscopic, and histological findings, pH monitoring, and measurement 
      of tissue markers and cytokines related to eosinophilic inflammation.This review 
      article aims to revisit the relatively novel concept of PPI-REE from a historical 
      perspective, given the strong belief that only GERD, as an acid peptic disorder, 
      could respond to the acid suppressing ability of PPI therapy, is becoming 
      outdated. Evolving evidence suggests that PPI-REE is genetically and 
      phenotypically undistinguishable from EoE and PPI therapy alone can almost 
      completely reverse allergic inflammation. As such, PPI-REE might constitute a 
      subphenotype of EoE and PPI therapy may be the first therapeutic step and diet/ 
      steroids may represent step up therapy. Possibly, the term PPI-REE will be soon 
      replaced by PPI-responsive EoE. The mechanism as to why some patients respond to 
      PPI therapy (PPI-REE) while others do not (EoE), remains to be elucidated.
FAU - Molina-Infante, Javier
AU  - Molina-Infante J
FAU - Katzka, David A
AU  - Katzka DA
FAU - Dellon, Evan S
AU  - Dellon ES
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Spain
TA  - Rev Esp Enferm Dig
JT  - Revista espanola de enfermedades digestivas
JID - 9007566
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Eosinophilic Esophagitis/*drug therapy/pathology
MH  - Gastroesophageal Reflux/drug therapy/etiology
MH  - Humans
MH  - Proton Pump Inhibitors/*therapeutic use
EDAT- 2015/01/21 06:00
MHDA- 2016/12/16 06:00
CRDT- 2015/01/21 06:00
PHST- 2015/01/21 06:00 [entrez]
PHST- 2015/01/21 06:00 [pubmed]
PHST- 2016/12/16 06:00 [medline]
PST - ppublish
SO  - Rev Esp Enferm Dig. 2015 Jan;107(1):29-36.