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Proton pump inhibitor-responsive oesophageal eosinophilia: too early to change clinical practice
  1. Amanda B Muir1,2,
  2. Mei-Lun Wang1,2,
  3. David Metz3,
  4. Gary Falk3,
  5. Jonathan Markowitz4,
  6. Jonathan M Spergel1,5,
  7. Chris A Liacouras1,2
  1. 1Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4Division of Pediatric Gastroenterology, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, USA
  5. 5Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Amanda B Muir, Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, 3615 Civic Center Blvd., ARC 902-E, Philadelphia, PA 19104, USA; muira{at}email.chop.edu

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We read the article by Molina-Infante et al1 with great concern as it proposes a major change in the current practice guidelines for managing patients presenting for care by gastroenterologists worldwide. Proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE)1 is characterised by an eosinophilic infiltrate of the oesophageal epithelium that is responsive to PPI therapy alone. The authors suggest that endoscopies should be performed prior to a therapeutic trial of PPI, so as not to miss this subtype of eosinophilic oesophagitis (EoE). We maintain that these two entities not only have yet to be proven to be the same pathophysiological process, but also that performing an initial endoscopy with biopsy would not change the current practice of first using a PPI before or after the …

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