Proton Pump Inhibitors for Inducing and Maintaining Remission in Eosinophilic Esophagitis: An Updated Systematic Review and Meta-Analysis.

Abstract

Background & aims: Proton pump inhibitor (PPI) therapy results in clinical and histological remission in approximately 50% of eosinophilic esophagitis (EoE) patients. We aimed to systematically update this topic due to cumulative data from pediatric/adult populations in wider geographical settings.

Methods: A search in MEDLINE, EMBASE, and SCOPUS databases was performed. Primary outcomes were clinical response and histological remission (< 15 eos/HPF). Subgroup analyses included age group, PPI drug and dosage, study design, data origin, and risk of bias. Data were pooled using random-effects models.

Results: Seventy-three studies comprising 7304 patients were included. PPI therapy led to clinical response in 65% (95%CI, 57.2-72.4; I² 0), and histological remission in 45.4% (95%CI, 41.6- 49.3) of patients, without differences between children and adults (41.2% vs. 48%, p 0.17). Overall, 34.1% (95%CI, 27.9-40.5) achieved <5 eos/HPF. Pooled effectiveness was significantly superior (p<0.001) in Western Pacific areas, principally Japan (67.9%), compared to American and European (40.6% and 44.4%, respectively). Histological remission was significantly higher with double PPI doses compared to standard (51.7% vs. 28.3%, p 0.005). Response was significantly higher in studies with lower risk of bias. Maintenance half doses led to sustained histological remission in 68.2% (95%CI, 63.7%-72.6%; I²=0) of patients.

Conclusions: PPI therapy induces clinic-histological remission in almost half of pediatric and adult EoE patients. Response to PPIs is significantly higher in Japan. Sustained remission is common on tapering PPI doses.