Proton Pump Inhibitors for Inducing and Maintaining Remission in Eosinophilic Esophagitis: An Updated Systematic Review and Meta-Analysis
Abstract
BACKGROUND & AIMS: Proton pump inhibitor (PPI) therapy results in clinical and histological remission in approximately 50% of eosinophilic esophagitis (EoE) patients. We aimed to systematically update this topic due to cumulative data from pediatric/adult populations in wider geographical settings.
METHODS: A search in MEDLINE, Embase, and Scopus databases was performed. Primary outcomes were clinical response and histological remission (<15 eosinophils per high-power field). Subgroup analyses included age group, PPI drug and dosage, study design, data origin, and risk of bias. Data were pooled using random-effects models.
RESULTS: Seventy-three studies comprising 7304 patients were included. PPI therapy led to clinical response in 65% (95% confidence interval [CI], 57.2-72.4; I2 = 0%) and histological remission in 45.4% (95% CI, 41.6%-49.3%) of patients, without differences between children and adults (41.4% vs 48%; P = .17). Overall, 34.1% (95% CI, 27.9%-40.5%) achieved <5 eosinophils per high-power field. Pooled effectiveness was significantly superior (P < .001) in Western Pacific areas, principally Japan (67.9%), compared with American and European areas (40.6% and 44.2%, respectively). Histological remission was significantly higher with double PPI doses compared with standard (51.7% vs 28.3%; P < .005). Response was significantly higher in studies with lower risk of bias. Maintenance half-doses led to sustained histological remission in 68.2% (95% CI, 63.7%-72.6%; I2…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 7,304 participants or records.
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