The following is a summary of “Proton Pump Inhibitor Therapy in Pediatric Eosinophilic Esophagitis: Predictive Factors and Long-Term Step-Down Efficacy,” published in the February 2023 issue of Gastroenterology and Nutrition by Junquera, et al.

Proton pump inhibitor (PPI) therapy for juvenile eosinophilic esophagitis (EoE) in real-world practice using a step-down strategy should be evaluated for both short- and long-term effectiveness, as well as for characteristics predicting PPI responsiveness.

The cross-sectional examination of the prospective countrywide RENESE registry allowed researchers to gather information about the effectiveness of PPIs. Included were kids with EoE who were just receiving PPI treatment. Peak eosinophilic count (<15 eosinophils (eos)/high-power field (hpf) was used to determine histological remission. Using multivariate logistic regression analysis, factors influencing PPI responsiveness were found.

After induction therapy, histological and clinical-histological remission was seen in 51.4% (n = 346) and 46.5% of kids, respectively. The normal endoscopic esophageal appearance was linked to a higher likelihood of histological remission (odds ratio (OR), 9.20; 95% CI, 2.10-40.16), while stenotic fibro phenotype was linked to a lower likelihood (OR, 0.36; 95% CI, 0.18-0.74). After 7 months (n = 108) and 16 months (n = 34), long-term therapy with a step-down strategy successfully sustained histological remission in 68.5% and 85.3% of children. Full initial histological remission with≤5 eos/hpf was linked to a greater chance of persistent histological remission (OR, 5.08; 95% CI, 1.75-14.68). Adverse incidents were few and minor.

Using a step-down approach, they demonstrated the effectiveness of PPIs for a sizable cohort of children with EoE who had sustained histological remission. Less frequently do children with fibro stenotic phenotypes respond to induction therapy. Moreover, patients were more likely to sustain long-term histological remission if they initially experienced complete histological remission.

Reference: journals.lww.com/jpgn/Abstract/2023/02000/Proton_Pump_Inhibitor_Therapy_in_Pediatric.16.aspx