Frazzoni L., Penagini R., De Bortoli N., et al. Role of Reflux in the Pathogenesis of Eosinophilic Esophagitis – Comprehensive Appraisal with Off- and On-PPI Impedance-PH Monitoring // Neurogastroenterology & Motility. 2019;31(Suppl. 1):e13626.

Авторы: Frazzoni L. / Penagini R. / de Bortoli N. / Mauro A. / Tolone S. / Marchi S. / Conigliaro R. / Savarino E.V. / Frazzoni M.

Role of Reflux in the Pathogenesis of Eosinophilic Esophagitis – Comprehensive Appraisal with Off- and On-PPI Impedance-PH Monitoring

L. Frazzoni^1,2, R. Penagini^3,4, N. De Bortoli⁵, A. Mauro^3,4, S. Tolone⁶, S. Marchi⁵,
R. Conigliaro⁷, E. Savarino⁸, M. Frazzoni¹

¹ Department of Specialized Medicine, Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
² Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
³ Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
⁴ Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
⁵ Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
⁶ Department of Surgery, Mini-Invasive and Bariatric Surgery Unit, University of Campania, Napoli, Italy
⁷ Department of Specialized Medicine, Digestive Endoscopy Unit, Baggiovara Hospital, Modena, Italy
⁸ Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy

Тезисы доклада (Abstracts) на 1-м национальном конгрессе SINGEM
(Societa Italiana di Neuro-Gastro-Enterologia i Motilita), Пиза, Италия, 28.02-01.03.2019 г.
Перевод на русский язык: Роль рефлюкса в патогенезе эозинофильного эзофагита - комплексная оценка с рН-импедансометрией на фоне терапии ИПП и без неё

Objective: The relationship between eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) has not been fully elucidated, as well as the mechanisms of response to proton pump inhibitor (PPI) therapy.

Methods: Prospective multicenter study comparing EoE and GERD patients with healthy controls. Patients were evaluated off- and on- PPI; responsiveness was assessed by histology. Impedance-pH appraisal included chemical clearance, assessed with post-reflux swallow-induced peristaltic wave (PSPW) index, and mucosal integrity measured with mean nocturnal baseline impedance (MNBI).

Results: Sixty consecutive EoE patients entered the study, and were compared to 60 age- and sex-matched healthy controls and to 60 typical GERD subjects. Number of total and acid refluxes were higher, while PSPW index and distal MNBI were significantly lower in EoE patients compared to healthy controls. EAET and total refluxes were higher in GERD than in EoE, while PSPW index was lower. MNBI was lower in EoE than in GERD. Impedance-pH parameters as modified by PPIs in EoE are shown in Table 1. On therapy, all reflux parameters improved in the 40 PPI-responsive EoE cases, but PSPW index was the only variable independently associated with PPI responsiveness (OR 1.143, P = 0.002). Among the 20 PPI-refractory patients, number of total refluxes and PSPW index were not modified by therapy. MNBI improved much more in PPI-responsive than in PPI-refractory cases. Off-PPI, MNBI values were lower in the distal than in the mid esophagus in PPI-responsive EoE but comparably low in PPI-refractory EoE.

Conclusions: Reflux plays a role in the pathogenesis of EoE, more relevant in PPI-responsive cases. PPIs mainly act by improving chemical clearance and reflux burden, i.e. by an anti-reflux action supporing their long term prescription in PPI-responsive EoE.

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