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Letter
Clarifying misunderstandings and misinterpretations about proton pump inhibitor-responsive oesophageal eosinophilia
  1. Javier Molina-Infante1,
  2. Ikuo Hirano2,
  3. Stuart J Spechler3
  4. on behalf of the PPI-REE Task Force of the European Society of Eosinophilic Oesophagitis (EUREOS)
  1. 1Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain
  2. 2Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3Department of Internal Medicine, VA North Texas Health Care System, and the University of Texas Southwestern Medical Center, Dallas, Texas, USA
  1. Correspondence to Dr Javier Molina-Infante, Department of Gastroenterology, Hospital San Pedro de Alcantara, Pablo Naranjo s/n, Caceres 10003, Spain; xavi_molina{at}hotmail.com

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We appreciate the interest of Muir et al1 in our Position Paper on proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE).2 Their letter highlights the ongoing controversies related to PPI-REE, particularly regarding practical diagnostic concerns in paediatric patients. We would like to address several issues raised by the authors:

  1. When the clinical presentation is consistent with gastro-oesophageal reflux disease (GORD), an empiric trial of PPI therapy is always appropriate. Teenagers and adults with dysphagia, however, should undergo an endoscopic procedure, because dysphagia is a red-flag symptom. In adult patients with dysphagia and suspected eosinophilic oesophagitis (EoE), a baseline endoscopy off PPI therapy has diagnostic value. This approach has not led to unnecessary endoscopies or diagnostic confusion, as suggested by Muir et al.1 Instead, it has elucidated the existence and improved our understanding of PPI-REE in adult patients.2 The different and more non-specific clinical presentation of …

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