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Response of eosinophilic oesophagitis to proton pump inhibitors is associated with impedance-pH parameters implying anti-reflux mechanism of action
- Source :
- Alimentary pharmacologytherapeuticsREFERENCES. 53(11)
- Publication Year :
- 2021
-
Abstract
- Background Proton pump inhibitors (PPIs) are effective therapies for eosinophilic oesophagitis (EoE), but the mechanism of action is uncertain. At on-PPI impedance-pH monitoring, improvement in oesophageal chemical clearance assessed with post-reflux swallow-induced peristaltic wave (PSPW) index characterises PPI-responsive EoE and reflux disease. Off-PPI, higher efficacy of the oesophago-salivary reflex as measured with PSPW-associated pH increments characterises PPI-responsive reflux disease and could typify PPI-responsive EoE as well. Aim To establish whether PPI responsiveness in EoE is associated with higher efficacy of the oesophago-salivary reflex. Methods Prospective multicentre study in EoE patients investigated with impedance-pH monitoring before starting PPI. Impedance-pH parameters in PPI-responsive and PPI-refractory cases were compared. PPI response was defined histologically. Results Considerable PSPW-associated pH increments (median 1.4 units) were found in 80 EoE patients, with significantly higher values in 48 PPI-responsive than in 32 PPI-refractory cases (1.8 vs 1.0, P = 0.02). Mucosal integrity, as measured with mean nocturnal baseline impedance was more severely impaired in the distal oesophagus in PPI-responsive cases, the gradient between mid and distal oesophagus being significantly higher (546 vs 137 Ω, P = 0.0002). PSPW-associated pH increments and the baseline impedance gradient between mid and distal oesophagus were independently associated with histological response at multivariable logistic regression; at receiver operating characteristic analysis, the area under the curve of PPI response calculated by combined assessment was 0.88. Conclusion Higher efficacy of oesophago-salivary reflex and more severe mucosal damage in the distal oesophagus are associated with EoE response to PPIs, implying an anti-reflux mechanism of action as most likely.
- Subjects :
- medicine.medical_specialty
Anti-reflux mechanism
Esophageal pH Monitoring
Electric Impedance
Humans
Hydrogen-Ion Concentration
Prospective Studies
Eosinophilic Esophagitis
Proton Pump Inhibitors
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Pharmacology (medical)
030212 general & internal medicine
Peristalsis
Hepatology
Receiver operating characteristic analysis
business.industry
Reflux
Area under the curve
Eosinophilic oesophagitis
Mechanism of action
Reflex
030211 gastroenterology & hepatology
medicine.symptom
business
Subjects
Details
- ISSN :
- 13652036
- Volume :
- 53
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Alimentary pharmacologytherapeuticsREFERENCES
- Accession number :
- edsair.doi.dedup.....9a8a02ec682495792dda8290f9950220