6Interactions between gastro-oesophageal reflux disease and eosinophilic oesophagitis
Section snippets
GORD, EoE and PPI-REE: who is who?
Updated similarities and differences between GORD, EoE and PPI-REE are summarized in Table 2.
GORD is a chronic condition that develops when the reflux of stomach contents, normally acid, causes troublesome symptoms and/or complications. The most common symptoms of GORD are heartburn and regurgitation, and to a lesser extent, dysphagia [23]. It mainly involves distal oesophagus and promotes a Th1 inflammatory response, with over expression of interleukin (IL)-8, monocyte chemoattractant protein
How do we define GORD in a patient with oesophageal eosinophilia?
GORD is one of the most common gastrointestinal disorders, affecting 10–20% of western population, typically males in their second to fifth decade of life. A presumptive diagnosis of GORD can be established upon typical symptoms (heartburn and regurgitation) and empirical PPI therapy can be prescribed accordingly [41]. Pathological oesophageal acid exposure, measured by pH monitoring, can be detected in 80% of patients with erosive GORD (ie, reflux oesophagitis) and 50% with non-erosive GORD
Interplay between GORD, EoE and PPI therapy
Of note, EoE adult patients are usually young males as well (3:1 ratio), so both diseases can largely coexist, with GORD in up to 30%–50% of EoE patients [20]. As such, coexistence of both disorders might occur within several clinical scenarios: 1) Both diseases coexist but unrelated; 2) GORD contributes to or causes EoE; 3) EoE contributes to or causes GORD [13]. The potential mechanisms whereby both disorders can interact are summarized in Table 3, as well as rationale basis for PPI therapy
Summary
GORD is the most common oesophageal disorder, usually responsive to PPI therapy, whereas EoE is an emerging disease unresponsive to PPI therapy. GORD and EoE were rigidly separated in 2007 guidelines according to oesophageal pH monitoring or response to PPI therapy. Updated guidelines in 2011 described a novel phenotype, proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), referring to patients who appear to have EoE clinically, but who achieve complete remission after PPI
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Cited by (21)
Endoscopic and histological characteristics in patients with eosinophilic esophagitis responsive and non-responsive to proton pump inhibitors
2020, Jornal de PediatriaCitation Excerpt :However, the correlation between eosinophilic infiltration of the esophagus with EoE and GERD was shown to be much more complex. Therefore, a third diagnostic category named PPI-responsive eosinophilic esophagitis (PPIREoE) was created, referring to the subgroup of patients with typical symptoms of EoE, but without GERD and with clinical and histological improvement after treatment with PPIs.10,11 Additionally, EoE and GERD can coexist in the same patient.
How to improve the diagnosis of eosinophilic esophagitis: Experience from a case series in Mexico
2017, Revista de Gastroenterologia de MexicoMechanisms and clinical management of eosinophilic oesophagitis: an overview
2023, Nature Reviews Gastroenterology and HepatologyClinical Manifestations of Eosinophilic Esophagitis in Children and Adolescents: A Single-Center, Matched Case-Control Study
2020, Pediatric Gastroenterology, Hepatology and NutritionPharmacological treatments for eosinophilic esophagitis: current options and emerging therapies
2020, Expert Review of Clinical ImmunologyClinical translational application of Raman spectroscopy to advance Benchside biochemical characterization to bedside diagnosis of esophageal diseases
2019, Journal of Gastroenterology and Hepatology (Australia)