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PPI-REE, GERD may share similar underlying cause
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GERD is common among patients with proton pump inhibitor-responsive esophageal eosinophilia, suggesting that the two conditions may share similar pathogenic mechanisms, according to an Italian study published in Alimentary Pharmacology and Therapeutics.
“Although recent data indicate that [eosinophilic esophagitis] and [proton pump inhibitor-responsive esophageal eosinophilia] present similar phenotypic appearance and similar histopathology, it is still unclear if PPI-REE is a GERD-related phenomenon, a subtype of EoE, or a completely unique entity,” the researchers wrote. “The aim of this study was to compare clinical, endoscopic and manometric features of EoE and PPI-REE patients with a control group of proven GERD patients, to verify whether any difference observed may provide further insights into the pathogenesis of the former two conditions.”
The researchers evaluated 35 patients with EoE, 17 with PPI-REE and 27 with GERD whom they consecutively enrolled from the gastroenterology and surgery units at the University of Padua from September 2013 to March 2015. All patients prospectively completed the validated GerdQ questionnaire and underwent high-resolution manometry.
Overall GerdQ scores were significantly lower in EoE patients compared with PPI-REE patients (P = .004).
Patients with EoE (94%) and PPI-REE (88%) both had higher rates of dysphagia compared with GERD patients (15%; both P < .0001). Moreover, patients with EoE less frequently reported heartburn (26% vs. 85%; P < .001) and regurgitation (17% vs. 74%; P < .001) compared with GERD patients, and also had lower GerdQ scores (P < .001). Conversely, the researchers observed no significant differences in heartburn, regurgitation and overall GerdQ scores between PPI-REE and GERD patients.
Patients with PPI-REE and GERD showed comparable frequencies of erosive esophagitis (35% vs. 48%), both of which were significantly higher compared with that of EoE patients (9%; P = .0446 and P = .0009, respectively).
Finally, patients with EoE had a lower frequency of GERD-related high-resolution manometry features compared with PPI-REE patients, but there were no significant differences between PPI-REE and GERD patients.
“In conclusion, our data suggest that typical reflux symptoms, erosive esophagitis and high-resolution manometry GERD-related features are more common in patients with PPI-REE than in patients with EoE, whereas endoscopic EoE-associated features and the presence of dysphagia as well as food impaction or chest pain were not able to distinguish between the two groups,” the researchers concluded. “These data support the hypothesis that PPI-REE and GERD may share similar pathogenic mechanisms, suggesting a close relationship between these two entities.”
The data also confirm the importance of PPI trials to accurately diagnose patients with esophageal eosinophilia, they added. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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