Carolina Gutiérrez-Junquera1, Sonia Fernández-Fernández2, M Luz Cilleruelo1, Ana Rayo2, Luis Echeverría3, Belén Borrell2, Enriqueta Román1. 1. Pediatric Gastroenterology Unit, Department of Pediatrics, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid. 2. Pediatric Gastroenterology Unit, Department of Pediatrics, Hospital Universitario Severo Ochoa, Leganés. 3. Pediatric Allergy Unit, Department of Pediatrics, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
Abstract
OBJECTIVES: Proton pump inhibitor (PPI)-responsive eosinophilic esophagitis (EoE) is frequently observed in children, but data on long-term treatment are scarce. The objective of this study is to evaluate the long-term efficacy and safety of PPIs in children with EoE. METHODS: This prospective study enrolled children with EoE and histological remission to an 8-week esomeprazole trial (1 mg/kg/dose, twice daily). Esomeprazole was maintained at 1 mg/kg/day for 1 year. Symptom recurrence and adverse events were monitored and a follow-up endoscopy was performed at 12 months. Complete histological remission was defined as ≤5 eosinophils/high-power field (eos/hpf), and partial histological remission as >5 and <15 eos/hpf. Patients had no concomitant dietary restrictions or topical steroid. RESULTS: Fifty-seven children were included. Histological remission on maintenance PPI therapy was present in 40 children (70.1%; 95% CI 56.5-81.5). Long-term remission rate was higher in children with initial complete histological remission than in those with partial remission (81% vs 50%, P = 0.014). Forty-nine children (86%) remained asymptomatic. Pretreatment clinical and histological findings and median PPI dose/kg/day were similar between relapsers and nonrelapsers. Eleven out of 12 children (91.6%) receiving esomeprazole 0.5 mg · kg · day for 12 additional months remained in remission. Mild and transient side effects without requiring PPI avoidance were observed in 5 children. CONCLUSIONS: Up to 70% of children with PPI-responsive EoE remain in histological and clinical remission on a low-dose maintenance treatment at 1-year follow-up, with adequate safety profile. Complete histological remission to an 8-week PPI trial was associated with higher probability of histological remission on maintenance therapy.
OBJECTIVES: Proton pump inhibitor (PPI)-responsive eosinophilic esophagitis (EoE) is frequently observed in children, but data on long-term treatment are scarce. The objective of this study is to evaluate the long-term efficacy and safety of PPIs in children with EoE. METHODS: This prospective study enrolled children with EoE and histological remission to an 8-week esomeprazole trial (1 mg/kg/dose, twice daily). Esomeprazole was maintained at 1 mg/kg/day for 1 year. Symptom recurrence and adverse events were monitored and a follow-up endoscopy was performed at 12 months. Complete histological remission was defined as ≤5 eosinophils/high-power field (eos/hpf), and partial histological remission as >5 and <15 eos/hpf. Patients had no concomitant dietary restrictions or topical steroid. RESULTS: Fifty-seven children were included. Histological remission on maintenance PPI therapy was present in 40 children (70.1%; 95% CI 56.5-81.5). Long-term remission rate was higher in children with initial complete histological remission than in those with partial remission (81% vs 50%, P = 0.014). Forty-nine children (86%) remained asymptomatic. Pretreatment clinical and histological findings and median PPI dose/kg/day were similar between relapsers and nonrelapsers. Eleven out of 12 children (91.6%) receiving esomeprazole 0.5 mg · kg · day for 12 additional months remained in remission. Mild and transient side effects without requiring PPI avoidance were observed in 5 children. CONCLUSIONS: Up to 70% of children with PPI-responsive EoE remain in histological and clinical remission on a low-dose maintenance treatment at 1-year follow-up, with adequate safety profile. Complete histological remission to an 8-week PPI trial was associated with higher probability of histological remission on maintenance therapy.
Authors: Anjan Dhar; Hasan N Haboubi; Stephen E Attwood; Marcus K H Auth; Jason M Dunn; Rami Sweis; Danielle Morris; Jenny Epstein; Marco R Novelli; Hannah Hunter; Amanda Cordell; Sharon Hall; Jamal O Hayat; Kapil Kapur; Andrew Robert Moore; Carol Read; Sarmed S Sami; Paul J Turner; Nigel J Trudgill Journal: Gut Date: 2022-05-23 Impact factor: 31.793
Authors: Carolina Gutiérrez-Junquera; Sonia Fernández-Fernández; M Luz Cilleruelo; Ana Rayo; Enriqueta Román Journal: Front Pediatr Date: 2018-05-08 Impact factor: 3.418
Authors: Edward B Mougey; Andre Williams; Ashlan J Kunz Coyne; Carolina Gutiérrez-Junquera; Sonia Fernández-Fernández; Maria Luz Cilleruelo; Ana Rayo; Luis Echeverría; Enriqueta Román; Carmen González Lois; Montserrat Chao; Hadeel Al-Atrash; John J Lima; James P Franciosi Journal: J Pediatr Gastroenterol Nutr Date: 2019-11 Impact factor: 2.839
Authors: José Antonio Cañas; Ana Tabares; Claudia Barbero; Daniel García-Sánchez; Beatriz Sastre; José Manuel Rodrigo-Muñoz; Ignacio Mahíllo-Fernández; Ana Rayo; Belén Borrell; Mª Luz Cilleruelo; Enriqueta Román; Sonia Fernandez-Fernandez; Carolina Gutiérrez-Junquera; Victoria Del Pozo Journal: J Pediatr Gastroenterol Nutr Date: 2020-12 Impact factor: 3.288