Original article
Systematic reviews and meta-analyses
Efficacy of Proton Pump Inhibitor Drugs for Inducing Clinical and Histologic Remission in Patients With Symptomatic Esophageal Eosinophilia: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.cgh.2015.07.041Get rights and content

Background & Aims

Proton pump inhibitor (PPI) therapy might lead to clinical and histologic remission in a significant proportion of patients with symptomatic esophageal eosinophilia (>15 eos/high-power field). We aimed to evaluate systematically the efficacy of PPI therapy for these patients.

Methods

A search in MEDLINE, EMBASE, and SCOPUS databases, and the American Gastroenterological Association Institute, American College of Gastroenterology, and United European Gastroenterology meetings abstract books, was performed. Primary outcomes were clinical response and histologic remission (<15 eos/high-power field) after PPI therapy. Secondary outcomes were the influence on the response to PPIs of age group, study design/quality, PPI type, doses and interval dosing, and pH monitoring results. Data were pooled using a random-effects model.

Results

Thirty-three studies (11 prospective studies) comprising 619 patients with symptomatic esophageal eosinophilia (188 children and 431 adults) were included. PPI therapy led to a clinical response in 60.8% (95% confidence interval, 48.38%–72.2%; I2 = 80.2) and histologic remission in 50.5% (95% confidence interval, 42.2%–58.7%; I2 = 67.5) of patients. No differences were observed regarding the study population (children vs adults), the type of publication, or its quality. PPIs were nonsignificantly more effective in prospective studies (52.6% vs 39.1%) administered twice daily compared with once daily (55.9% vs 49.7%), and with pathologic pH monitoring (65.4% vs 49.3%). A significant publication bias in favor of studies reporting histologic responses to PPIs was observed.

Conclusions

PPI therapy induces clinicohistologic remission in half of patients with symptomatic esophageal eosinophilia. This finding should be interpreted with caution because of poor-quality evidence, heterogeneity, and publication bias.

Section snippets

Methods

This systematic review has been registered in the PROSPERO International prospective register of systematic reviews (www.crd.york.ac.uk/PROSPERO; register no. CRD42015017569), and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements.17

Results

The search strategy yielded 1008 references; 961 were excluded after examining the title and abstract because they did not fulfill the inclusion criteria. Among the remaining 47 documents retrieved for complete evaluation, 14 were excluded because of a lack of data for calculations (11 documents) or either repeated or duplicated information (3 documents). Finally, 33 studies (comprising 28 full reports11, 12, 13, 14, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42

Discussion

The present systematic review and meta-analysis shows that PPIs are effective drugs for achieving complete remission in half of patients with symptomatic esophageal eosinophilia compatible with EoE. Interestingly, the prevalence of histologic remission on PPI therapy reported here is slightly higher than that reported in a previous nonsystematic review article, especially in children (23%–40%).16 This discrepancy likely is related to the inclusion of case reports and abstracts because the

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      Citation Excerpt :

      However, we observed a lack of interest in evaluating these novel drugs in EoC, which will likely remain without labelled therapeutic options in the longer term. PPIs are currently considered as one of the possible first line treatments for EoE [5,7,8] because they are effective in controlling esophageal inflammation and symptoms [22,23]. However, since 2008, only five trials registered on clinicaltrials.gov investigated treatment with PPIs, either as monotherapy or in combination with other treatments.

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    Conflicts of interest The authors disclose no conflicts.

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