Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: History, Mechanisms, Efficacy, and Future Directions

James P Franciosi; Edward B Mougey; Evan S Dellon; Carolina Gutierrez-Junquera; Sonia Fernandez-Fernandez; Rajitha D Venkatesh; Sandeep K Gupta

doi:10.2147/JAA.S274524

Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: History, Mechanisms, Efficacy, and Future Directions

J Asthma Allergy. 2022 Feb 26:15:281-302. doi: 10.2147/JAA.S274524. eCollection 2022.

Authors

James P Franciosi^{1

2}, Edward B Mougey³, Evan S Dellon⁴, Carolina Gutierrez-Junquera⁵, Sonia Fernandez-Fernandez⁶, Rajitha D Venkatesh⁷, Sandeep K Gupta⁸

Affiliations

¹ Division of Gastroenterology, Nemours Children's Hospital, Orlando, FL, USA.
² College of Medicine, University of Central Florida, Orlando, FL, USA.
³ Center for Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, FL, USA.
⁴ Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
⁵ Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Autonomous University of Madrid, Madrid, Spain.
⁶ Pediatric Gastroenterology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain.
⁷ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.
⁸ Section of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children, Indiana University School of Medicine and Community Health Network, Indianapolis, IN, USA.

Abstract

Over the past decade, the role of proton pump inhibitor (PPI) medication has evolved from a diagnostic tool for Eosinophilic Esophagitis (EoE), by excluding patients with PPI responsive esophageal eosinophilia (PPI-REE), to a therapy for EoE. This transition resulted from the Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the Appraisal of Guidelines for Research and Evaluation II (AGREE) Conference to support PPI therapy for EoE in children and adults. Additional recent advances have suggested a role for genetic variations that might impact response to PPI therapy for EoE. This review article will explore a brief background of EoE, the evolution of PPI therapy for EoE and its proposed mechanisms, efficacy and safety in children and adults, and considerations for future PPI precision medicine in patients with EoE.

Keywords: EoE; PPI; eosinophilic esophagitis; precision medicine; proton pump inhibitor medication.

Publication types

Review

Grants and funding

This work was funded by a Nemours Research Foundation grant to JPF.