Effectiveness of Potassium-Competitive Acid Blockers and Proton Pump Inhibitors on Esophageal Wall Thickening in Eosinophilic Esophagitis.

Background/aims: The efficacy of proton pump inhibitors (PPIs) and potassium-competitive acid blockers (P-CABs) in the treatment of eosinophilic esophagitis (EoE) has been well established. This study aimed to clarify the impact of PPIs/P-CABs on esophageal wall thickness and clinical symptoms in EoE patients.

Methods: Patients who were consecutively diagnosed with asymptomatic esophageal eosinophilia and EoE and treated with PPIs/P-CABs were assessed in this study. Esophageal wall thickness before and after treatment was evaluated using endoscopic ultrasonography.

Results: Thirteen patients were asymptomatic, while 20 presented with gastrointestinal symptoms at baseline. Treatment led to significant decreases in symptom scores, the EoE Endoscopic Reference Scores, and the EoE Histologic System Scores compared with those at baseline. Following treatment, significant reductions were observed in the total esophageal wall thickness (TWT) and thickness from the surface to the muscular layer (TSM) across the upper, middle, and lower esophagus compared with baseline values (median TWT, 2.0 mm vs 1.7 mm, p=0.005; 2.3 mm vs 1.9 mm, p=0.004; 2.9 mm vs 2.3 mm, p<0.001; median TSM, 1.1 mm vs 0.9 mm, p=0.001; 1.3 mm vs 1.1 mm, p<0.001; 1.8 mm vs 1.4 mm, p<0.001, respectively). Similar trends were observed in the lower esophagus of patients with asymptomatic esophageal eosinophilia, with the TWT and TSM values significantly lower after treatment (median TWT, 2.7 mm vs 2.5 mm, p=0.045; median TSM, 1.7 mm vs 1.5 mm, p=0.008, respectively). These findings were consistent in patients treated with either PPIs (p=0.027 and p=0.018, respectively) or P-CABs (p<0.001 and p<0.001, respectively).

Conclusions: PPIs/P-CABs reduce esophageal wall thickening, particularly in the mucosal and submucosal layers.