Eosinophilic esophagitis (EoE) is an immune/antigen-mediated, progressive fibrostenotic disease characterized by symptoms of esophageal dysfunction and abnormal eosinophilic infiltration in the esophagus.

Despite treatment modalities of dietary antigen elimination or Topical corticosteroids, a subset of patients do not have clinical or histologic response. Even with resolution of superficial epithelial eosinophilia, patients may still have progressive subepithelial fibrosis, which may lead to esophageal strictures over time and requiring recurrent esophageal dilation.

Chronic uncontrolled eosinophilic inflammation ultimately leads to remodeling and alters the structure and function of the esophagus, with dysmotility, esophageal rigidity, progressive dysphagia and food impaction and, finally, stricture formation. The endoscopic signs of EoE remodeling can be obvious with fibrostenotic features such as rings and strictures that cause food impaction.

Role of Proton pump inhibitor (PPI) in Eosinophilic esophagitis (EoE)

The main effect of PPIs is the inhibition of the H⁺/K⁺ ATPase pump in the parietal gastric cells responsible for acid secretion. Acid suppression can be beneficial for EoE since acid reflux can damage intercellular connections between epithelial cells, leading to an increase in permeability which, in turn, potentially allows penetration of the mucosa by allergens which cause EoE.

EoE patients may also benefit from PPIs through anti-inflammatory properties. PPIs can inhibit T-helper 2 cytokine-induced eotaxin-3 expression in esophageal epithelial cells in adult patients with EoE, potentially reducing eosinophil recruitment

This study report found effective PPI therapy for EoE significantly reduced endoscopic esophageal fibrosis in the short term. 

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