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Long-Term Response in PPI-REE is influenced by CYP2C19 genotype

Written by Alfredo J Lucendo | Wednesday, September 30th, 2015

Molina-Infante J, et al. Long-Term Loss of Response in Proton-Pump Inhibitor-Responsive Esophageal Eosinophilia Is Uncommon and Infl uenced by CYP2C19 Genotype and Rhinoconjunctivitis. Am J Gastroenterol 2015; doi: 10.1038/ajg.2015.314

Half of patients with clinical phenotype of EoE can show disease remission after 8 weeks of PPI treatment. However, the durability and factors influencing the long-term efficacy of PPI therapy in these patients were currently unknown.

A research conducted in centers of Spain and United States aimed to evaluate the durability of long-term efficacy of PPI therapy in patients who achieve histological remmission of EoE with these drugs, and the factors influencing it.

Seventy-five PPI-REE patients with a mean follow-up period of 26 months (12–85) were retrospectively analyzed. 73% of them had sustained histological remission on low-dose PPI therapy.

Loss of response was significantly higher in those patients with a CYP2C19 rapid metabolizer genotype (36% vs. 6%, p=0.01) and with associated rhinoconjuctivitis (40% vs. 13%, p=0.007). The multivariate analysis confirmed that both CYP2C19 rapid metabolizer genotype (OR 12.5; 95%CI 1.3–115.9) and the associaton of rhinoconjunctivitis (OR 8.6; 95% CI 1.5–48.7) were independent predictors of loss of response in such as patients.

Interestingly, the recurrence of eosinophilic inflammation while on low PPI doses was more common in the distal esophageal third, and most of relapsers (9/10), regained histological remission after PPI dose intensification.

These data are the first of their kind to help inform clinicians and patients with PPI-REE /EoE what to expect for long-term outcomes.

Read the full paper at: Am J Gastroenterol 2015; http://www.ncbi.nlm.nih.gov/pubmed/26416193