Efficacy of proton pump inhibitor therapy for eosinophilic oesophagitis in 630 patients: results from the EoE connect registry
Efficacy of proton pump inhibitor therapy for eosinophilic oesophagitis in 630 patients: results from the EoE connect registry
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DOI：
10.1111/apt.15957
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发表时间：
2020-07-17
影响因子：
7.6
通讯作者：
Lucendo, Alfredo J.
中科院分区：
文献类型：
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作者：
Laserna-Mendieta, Emilio J.;Casabona, Sergio;Lucendo, Alfredo J.
背景质子泵抑制剂(PPI)是嗜酸性食管炎(EoE)患者最常用的一线治疗药物。然而，与EoE中的PPI相关的许多方面仍然未知。目的评估PPI治疗EoE的临床效果。方法本横断面研究从多中心EoE CONNECT数据库中收集有关PPI疗效的数据。临床缓解定义为吞咽困难症状评分下降50%；组织学缓解定义为嗜酸性粒细胞数峰值低于15个/高倍视野。通过二元Logistic回归多因素分析确定影响PPI治疗效果的因素。结果总共有630名患者(76名儿童)接受了PPI，作为初始治疗(n=600)或在其他治疗无效后(n=30)。PPI治疗后，48.8%的患者嗜酸性粒细胞密度低于15个/高倍视野，71.0%的患者症状评分较治疗前下降50%。表型为炎症型而不是狭窄型的EoE患者在PPI治疗后获得临床组织学缓解(OR 3.7；95%CI，1.4~9.5)，以及将治疗时间从8周延长到12周(OR 2.7；95%CI，1.3~5.3)。在达到EoE的临床组织学缓解后，69.9%的病例有效地维持了PPI剂量的减少，但在表型狭窄的患者中效果往往较差。结论炎症性EoE的表型和治疗持续12周是诱导EoE缓解的最大益处。狭窄的表型降低了PPI治疗的初始和长期应答率。
Background Proton pump inhibitors (PPIs) are the most commonly used first-line therapy for patients with eosinophilic oesophagitis (EoE). However, many aspects related to PPIs in EoE are still unknown. Aims To assess the effectiveness of PPI therapy for EoE in real-world practice. Methods This cross-sectional study collected data on PPI efficacy from the multicentre EoE CONNECT database. Clinical remission was defined as a decrease >= 50% in dysphagia symptom score; histological remission was defined as a peak eosinophil count below 15 eosinophils per high-power field. Factors associated with effectiveness of PPI therapy were identified by binary logistic regression multivariate analyses. Results Overall, 630 patients (76 children) received PPI as initial therapy (n = 600) or after failure to respond to other therapies (n = 30). PPI therapy achieved eosinophil density below 15 eosinophils per high-power field in 48.8% and a decreased symptom score >= 50% from baseline in 71.0% of patients. More EoE patients with an inflammatory rather than stricturing phenotype accomplished clinico-histological remission after PPI therapy (OR 3.7; 95% CI, 1.4-9.5); as well as those who prolonged treatment length from 8 to 12 weeks (OR 2.7; 95% CI, 1.3-5.3). After achieving clinico-histological remission of EoE, PPI dosage reduction was effectively maintained in 69.9% of cases, but tended to be less effective among patients with a stricturing phenotype. Conclusions Inflammatory EoE phenotype and treatment duration up to 12 weeks provided the greatest benefits for inducing remission of EoE. A stricturing phenotype decreased response rates to PPI therapy both initially and in the long term.