TY - JOUR
T1 - Proton Pump Inhibitor Therapy in Eosinophilic Esophagitis
T2 - Predictors of Nonresponse
AU - Alexander, Ryan
AU - Alexander, Jeffrey A.
AU - Akambase, Joseph
AU - Harmsen, William Scott
AU - Geno, Debra
AU - Tholen, Crystal
AU - Katzka, David A.
AU - Ravi, Karthik
N1 - Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/9
Y1 - 2021/9
N2 - Background: Identification of clinical predictors of response to first-line therapies for EoE is needed to guide initial medical management. Study Design: A retrospective analysis of patients diagnosed with EoE from 2011 to 2018 was conducted. Clinical and diagnostic variables including demographics, endoscopic, and esophagram findings were compared between PPI responders and PPI nonresponders. All patients underwent a standard 8-week twice-daily PPI trial, with PPI responsiveness defined as < 15 eos/hpf on repeat EGD. Univariate and multivariable analyses were conducted to identify risk factors for nonresponse, and ROC curves were created to identify cutoff values. Results: A total of 223 EoE patients (135 male, median age 39 (29–51)) were identified, with PPI nonresponse (PPI-NR) in 71% of patients. PPI-NR was seen in all 10 patients with failure of scope passage, with an OR of 9.06 by univariate analysis (P = 0.1485). In a multivariable model, age per 10 years (OR 0.71; P = 0.007), BMI per 1 kg/m2 (OR 0.94; P = 0.03), and peripheral eosinophil count per 100 per mm3 (OR 1.37; P = 0.003) were independent risk factors. Dichotomization to maximize sensitivity and specificity identified age ≤ 36 years old, BMI ≤ 25.2 kg/m2, and peripheral eos > 460 per mm3 as predictive thresholds for PPI-NR. The probability of PPI-NR was 72.4–84.5% with 1 risk factor, 87.9–93.8% with 2 risk factors, and 97.2% with all 3 risk factors. Conclusions: Young age, reduced BMI, elevated peripheral eosinophil count, and likely inability to pass an endoscope predict lack of response to PPIs in patients with EoE.
AB - Background: Identification of clinical predictors of response to first-line therapies for EoE is needed to guide initial medical management. Study Design: A retrospective analysis of patients diagnosed with EoE from 2011 to 2018 was conducted. Clinical and diagnostic variables including demographics, endoscopic, and esophagram findings were compared between PPI responders and PPI nonresponders. All patients underwent a standard 8-week twice-daily PPI trial, with PPI responsiveness defined as < 15 eos/hpf on repeat EGD. Univariate and multivariable analyses were conducted to identify risk factors for nonresponse, and ROC curves were created to identify cutoff values. Results: A total of 223 EoE patients (135 male, median age 39 (29–51)) were identified, with PPI nonresponse (PPI-NR) in 71% of patients. PPI-NR was seen in all 10 patients with failure of scope passage, with an OR of 9.06 by univariate analysis (P = 0.1485). In a multivariable model, age per 10 years (OR 0.71; P = 0.007), BMI per 1 kg/m2 (OR 0.94; P = 0.03), and peripheral eosinophil count per 100 per mm3 (OR 1.37; P = 0.003) were independent risk factors. Dichotomization to maximize sensitivity and specificity identified age ≤ 36 years old, BMI ≤ 25.2 kg/m2, and peripheral eos > 460 per mm3 as predictive thresholds for PPI-NR. The probability of PPI-NR was 72.4–84.5% with 1 risk factor, 87.9–93.8% with 2 risk factors, and 97.2% with all 3 risk factors. Conclusions: Young age, reduced BMI, elevated peripheral eosinophil count, and likely inability to pass an endoscope predict lack of response to PPIs in patients with EoE.
KW - Age
KW - Body mass index
KW - Eosinophilic esophagitis
KW - Peripheral eosinophil count
KW - Proton pump inhibitor
KW - Risk factor
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U2 - 10.1007/s10620-020-06633-4
DO - 10.1007/s10620-020-06633-4
M3 - Article
C2 - 32995996
AN - SCOPUS:85091728636
SN - 0163-2116
VL - 66
SP - 3096
EP - 3104
JO - Digestive diseases and sciences
JF - Digestive diseases and sciences
IS - 9
ER -