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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:
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 …
Contributors JM-I, IH and SJS contributed equally to this letter.
Competing interests IH is a consultant for Shire, Regeneron, Roche and Receptors. He receives grant support from NIH U54 AI117804 (part of the Rare Disease Clinical Research Network (RDCRN), an initiative of the Office of Rare Disease Research (ORDR), NCATS and is funded through collaboration between NCATS, NIAID and NIDDK). SJS: The Office of Medical Research, Departments of Veterans Affairs (SJS), the National Institutes of Health (R01-DK63621 to SJS, R01-CA134571 to SJS) and NASPGHAN Foundation/AstraZeneca Award (EC).
Provenance and peer review Not commissioned; internally peer reviewed.