Management of proton pump inhibitor responsive-esophageal eosinophilia and eosinophilic esophagitis: controversies in treatment approaches

Expert Rev Gastroenterol Hepatol. 2015;9(11):1359-69. doi: 10.1586/17474124.2015.1088384. Epub 2015 Sep 12.


Eosinophilic esophagitis (EoE) is a chronic immune-mediated clinicopathologic disease. The prevalence of EoE is approximately 1/2000 persons, EoE is now the most common cause of food impactions, with healthcare expenditures approaching US$ 1 billion annually. This article will discuss challenges related to proton pump inhibitor responsive esophageal eosinophilia, including distinguishing this condition from EoE and understanding the mechanisms behind the PPI response. For EoE, we will review multiple ongoing debates about treatment and monitoring strategies, including selecting treatment outcomes, optimizing medication formulations, approaching the steroid-refractory patient, conducting dietary elimination, prescribing long-term maintenance therapy and performing esophageal dilation.

Keywords: challenges; endoscopy; eosinophilic esophagitis; management; proton pump inhibitor responsive esophageal eosinophilia.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Diagnosis, Differential
  • Diet / adverse effects
  • Dilatation
  • Drug Administration Schedule
  • Eosinophilia / diagnosis
  • Eosinophilia / drug therapy*
  • Eosinophilia / epidemiology
  • Eosinophilic Esophagitis / diagnosis
  • Eosinophilic Esophagitis / drug therapy*
  • Eosinophilic Esophagitis / epidemiology
  • Esophageal Diseases / diagnosis
  • Esophageal Diseases / drug therapy*
  • Esophageal Diseases / epidemiology
  • Esophagoscopy
  • Humans
  • Predictive Value of Tests
  • Proton Pump Inhibitors / administration & dosage
  • Proton Pump Inhibitors / adverse effects
  • Proton Pump Inhibitors / therapeutic use*
  • Remission Induction
  • Risk Factors
  • Steroids / therapeutic use
  • Time Factors
  • Treatment Outcome


  • Proton Pump Inhibitors
  • Steroids