Division of Digestive Diseases and Nutrition.
Department of Medicine, Division of Evidence Based Medicine and Outcomes Research.
J Clin Gastroenterol. 2018 Aug;52(7):590-595. doi: 10.1097/MCG.0000000000000813.
Despite consensus eosinophilic esophagitis (EoE) statement published in 2011 calling for a 2-month trial of protons pump inhibitor (PPI), the guidelines are not followed by many. We studied the practice patterns in our community and response to a PPI retrial in patients previously diagnosed with "idiopathic EoE."
All patients presenting to the senior author's practice with suspected EoE from 2011 to 2015. Two cohorts were studied: (1) patients diagnosed in the community as "idiopathic EoE"; (2) treatment naïve patients given a PPI trial at University of South Florida. PPI responsive eosinophilia was defined after 2 months of high dose PPIs after initial diagnosis of mucosal eosinophilia and histologic response of <15 eosinophils per HPF. SPSS v19.0 was used to calculate mean difference and odds ratios (OR) and 95% confidence intervals.
In total, 78 patients met inclusion criteria, 46 patients had outside diagnosis of "idiopathic EoE," and 41 patients received a PPI trial at University of South Florida. In total, 34/46 (73.9%) community patients were placed on a PPI, 3/46 (6.5%) were placed on elimination diets, 31/46 (67.4%) steroids, and 21/46 (45.7%) were treated with both steroids/PPIs. Fewer patients received PPI trials in the community 3/46 (6.5%) versus 26/34 (76.5%) at our center [OR, 46.6 (95% CI, 11.3-191.5); P<0.0001]. In total, 12/26 (46.2%) were PPI responders on our retrial despite previously being diagnosed with idiopathic EoE. The group initially diagnosed at our center had a higher PPI response rate 12/15 (80%) versus 12/26 (46.2%) in the community group [OR, 7.58 (1.42, 40.55; P=0.018)].
The importance of a PPI trial is misunderstood and may be confused with the more traditional PPI trial for gastroesophageal reflux disease. This algorithm is critical and should be done before empiric steroids/diet therapies.
尽管 2011 年发布的嗜酸性食管炎（EoE）共识声明呼吁进行为期 2 个月的质子泵抑制剂（PPI）试验，但许多人并未遵循该指南。我们研究了我们社区的实践模式，并对以前被诊断为“特发性 EoE”的患者进行了 PPI 再试验的反应。
2011 年至 2015 年期间，所有因疑似 EoE 到资深作者诊所就诊的患者均入组本研究。研究了两个队列：（1）社区诊断为“特发性 EoE”的患者；（2）在南佛罗里达大学接受 PPI 试验的治疗初治患者。在最初诊断为黏膜嗜酸性粒细胞增多和组织学反应<15 个嗜酸性粒细胞/高倍视野后，2 个月后给予高剂量 PPI 治疗后，定义 PPI 反应性嗜酸性粒细胞增多症。使用 SPSS v19.0 计算均值差异和比值比（OR）和 95%置信区间。
总共有 78 名患者符合纳入标准，46 名患者有社区诊断的“特发性 EoE”，41 名患者在南佛罗里达大学接受了 PPI 试验。总共有 34/46（73.9%）的社区患者接受了 PPI 治疗，3/46（6.5%）接受了消除饮食治疗，31/46（67.4%）接受了类固醇治疗，21/46（45.7%）接受了类固醇/PPIs 联合治疗。与我们中心相比，社区中接受 PPI 试验的患者更少，3/46（6.5%）与 26/34（76.5%）[OR，46.6（95%CI，11.3-191.5）；P<0.0001]。在我们的再试验中，总共有 12/26（46.2%）尽管先前被诊断为特发性 EoE，但对 PPI 有反应。与社区组相比，在我们中心最初诊断的患者 PPI 反应率更高，12/15（80%）与 12/26（46.2%）[OR，7.58（1.42，40.55；P=0.018）]。
PPI 试验的重要性被误解，可能与更传统的胃食管反流病的 PPI 试验混淆。该算法至关重要，应在经验性类固醇/饮食治疗之前进行。
