Long-term Treatment With Proton Pump Inhibitors Is Effective in Children With Eosinophilic Esophagitis. Issue 2 (August 2018)

• Record Type: Journal Article
• Authors: Gutiérrez-Junquera, Carolina; Fernández-Fernández, Sonia; Cilleruelo, M. Luz; Rayo, Ana; Echeverría, Luis; Borrell, Belén; Román, Enriqueta
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 67:Issue 2(2018)
• Publication Date: 2018-08
• Subjects: adolescents -- children -- efficacy -- eosinophilic esophagitis -- long-term safety -- proton pump inhibitors; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000001952
• Languages: English
• ISSNs: 0277-2116

Abstract

ABSTRACT: Objectives: Proton pump inhibitor (PPI)-responsive eosinophilic esophagitis (EoE) is frequently observed in children, but data on long-term treatment are scarce. The objective of this study is to evaluate the long-term efficacy and safety of PPIs in children with EoE. Methods: This prospective study enrolled children with EoE and histological remission to an 8-week esomeprazole trial (1 mg/kg/dose, twice daily). Esomeprazole was maintained at 1 mg/kg/day for 1 year. Symptom recurrence and adverse events were monitored and a follow-up endoscopy was performed at 12 months. Complete histological remission was defined as ⩽5 eosinophils/high-power field (eos/hpf), and partial histological remission as >5 and <15 eos/hpf. Patients had no concomitant dietary restrictions or topical steroid. Results: Fifty-seven children were included. Histological remission on maintenance PPI therapy was present in 40 children (70.1%; 95% CI 56.5–81.5). Long-term remission rate was higher in children with initial complete histological remission than in those with partial remission (81% vs 50%, P = 0.014). Forty-nine children (86%) remained asymptomatic. Pretreatment clinical and histological findings and median PPI dose/kg/day were similar between relapsers and nonrelapsers. Eleven out of 12 children (91.6%) receiving esomeprazole 0.5 mg · kg −1 · day −1 for 12 additional months remained in remission. Mild and transient side effects without requiring PPI avoidance were observed in 5 children. Conclusions: Up to 70% of children with PPI-responsive EoE remain in histological and clinical remission on a low-dose maintenance treatment at 1-year follow-up, with adequate safety profile. Complete histological remission to an 8-week PPI trial was associated with higher probability of histological remission on maintenance therapy.