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Proton Pump Inhibitor Therapy in Pediatric Eosinophilic Esophagitis: Predictive Factors and Long-Term Step-Down Efficacy.
Gutiérrez-Junquera, Carolina; Fernández-Fernández, Sonia; Domínguez-Ortega, Gloria; Vila Miravet, Víctor; García-Puig, Roger; La Orden-Izquierdo, Enrique; Peña Quintana, Luis; Barrio Torres, Josefa; Medina Benítez, Enrique; Leis, Rosaura; García-Romero, Ruth; Fernández de Valderrama, Ana; Vecino López, Raquel; Donado Palencia, Paloma.
Affiliation
  • Gutiérrez-Junquera C; From Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Universidad Autónoma de Madrid, Spain.
  • Fernández-Fernández S; Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
  • Domínguez-Ortega G; Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
  • Vila Miravet V; Hospital Universitario Maternoinfantil Sant Joan de Déu, Barcelona, Spain.
  • García-Puig R; Hospital Universitario Mutua Terrassa, Barcelona, Spain.
  • La Orden-Izquierdo E; Hospital Universitario Infanta Elena, Valdemoro, Universidad Francisco de Vitoria, Madrid, Spain.
  • Peña Quintana L; Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias, CIBER OBNISCIII, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
  • Barrio Torres J; Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Medina Benítez E; Hospital Universitario Doce de Octubre, Madrid, Spain.
  • Leis R; Hospital Clínico Universitario de Santiago de Compostela, IDIS-USC, Santiago de Compostela, Spain.
  • García-Romero R; Hospital Universitario Infantil Miguel Servet, Zaragoza, Spain.
  • Fernández de Valderrama A; Hospital Universitario de Burgos, Burgos, Spain.
  • Vecino López R; Hospital Clínico San Carlos, Madrid, Spain.
  • Donado Palencia P; Hospital Universitario de Ciudad Real, Ciudad Real, Spain.
J Pediatr Gastroenterol Nutr ; 76(2): 191-198, 2023 02 01.
Article in En | MEDLINE | ID: mdl-36416845
ABSTRACT

OBJECTIVES:

To assess the short- and long-term efficacy of proton pump inhibitor (PPI) therapy for pediatric eosinophilic esophagitis (EoE) in real-world practice with a step-down strategy, and to evaluate factors predictive of PPI responsiveness.

METHODS:

We collected data regarding the efficacy of PPIs during this cross-sectional analysis of the prospective nationwide RENESE registry. Children with EoE treated with PPI monotherapy were included. Histological remission was defined as a peak eosinophilic count of <15 eosinophils (eos)/high-power field (hpf). Factors associated with PPI responsiveness were identified using multivariate logistic regression analysis.

RESULTS:

After induction therapy, histological and clinico-histological remission were observed in 51.4% (n = 346) and 46.5% of children, respectively. Normal endoscopic appearance of the esophagus was associated with a higher possibility [odds ratio (OR), 9.20; 95% confidence interval (CI), 2.10-40.16], and fibrostenotic phenotype was associated with a lower possibility (OR, 0.36; 95% CI, 0.18-0.74) of histological remission. Long-term therapy with a step-down strategy effectively maintained histological remission in 68.5% and 85.3% of children at 7 months (n = 108) and 16 months (n = 34), respectively. Complete initial histological remission (≤5 eos/hpf) was associated with a higher possibility of sustained histological remission (OR, 5.08; 95% CI, 1.75-14.68). Adverse events were infrequent and mild.

CONCLUSIONS:

We confirmed the efficacy of PPIs for a large cohort of children with EoE with sustained histological remission using a step-down strategy. Children with fibrostenotic phenotypes are less likely to respond to induction therapy. Furthermore, patients with complete initial histological remission are more likely to experience long-term histological remission.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Eosinophilic Esophagitis Type of study: Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Pediatr Gastroenterol Nutr Year: 2023 Document type: Article Affiliation country: España

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Eosinophilic Esophagitis Type of study: Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Pediatr Gastroenterol Nutr Year: 2023 Document type: Article Affiliation country: España