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Title: | Proton pump inhibitor therapy in pediatric eosinophilic esophagitis: predictive factors and long-term step-down efficacy | Authors: | 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 |
UNESCO Clasification: | 32 Ciencias médicas 320110 Pediatría 320503 Gastroenterología |
Keywords: | Eosinophilic esophagitis Children Histological remission Adverse events Registry |
Issue Date: | 2022 | Journal: | Journal of Pediatric Gastroenterology and Nutrition | 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. | URI: | https://accedacris.ulpgc.es/handle/10553/119680 | ISSN: | 0277-2116 | DOI: | 10.1097/MPG.0000000000003660 | Source: | Journal of Pediatric Gastroenterology and Nutrition [0277-2116], (Noviembre 2022) |
Appears in Collections: | Artículos |
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