Updated similarities and differences between GORD, PPI-REE and EoE
| GORD | PPI-REE | EoE | |
|---|---|---|---|
| Age | Adults>children | Children and young adults | Children and young adults |
| Gender | Male=Female | Male predominance | Male predominance |
| Dominant symptom | Heartburn, regurgitation | Dysphagia | Dysphagia |
| Food impaction | Uncommon | Common | Common |
| Endoscopic findings | Normal endoscopy (70–80%) Erosions, ulcers, strictures, Barrett's oesophagus, oesophageal adenocarcinoma | Normal endoscopy (<10%) Oedema, rings, exudates furrows, strictures, crêpe-paper oesophagus, narrow calibre oesophagus | Normal endoscopy (<10%) Oedema, rings, exudates. furrows, strictures, crêpe-paper oesophagus, narrow calibre oesophagus |
| Histology and inflammatory cells | Usually <5–10 eos/HPF Neutrophils, lymphocytes, low-grade eosinophilia | >15 eos/HPF Eosinophils and mast cells | >15 eos/HPF Eosinophils and mast cells |
| Oesophageal acid exposure on pH monitoring | Mostly positive | Positive and negative | Negative and positive |
| Primary treatment | Inhibitors of gastric acid secretion, including PPIs, surgical fundoplication | PPI therapy, unclear whether other inhibitors of gastric acid secretion are effective | Topical steroids Elimination diet |
| Aetiology | Reflux of gastric contents | Unclear | Food/airborne allergens |
| Type of immune response/involved chemo/cytokines | Th1 IL-8, MCP-1, RANTES | Th2 Eotaxin-3, IL-5, IL-13 | Th2 Eotaxin-3, IL-5, IL-13 |
| EoE transcriptome panel | Not expressed | Similar expression to EoE | Similar expression to PPI-REE |
| Specific molecular effect of therapy | – | PPIs downregulate Th2 inflammation and normalise EoE gene expression | Topical steroids downregulate Th2 inflammation and normalise EoE gene expression |
EoE, eosinophilic oesophagitis; IL, interleukin; MCP-1, monocyte chemoattractant protein-1; PPI, proton pump inhibitor; REE, responsive oesophageal eosinophilia.