Optimizing Treatment

“How does twice-daily proton pump inhibitor (PPI) dosing affect eosinophilic esophagitis (EoE) patients?”

A recent study published in The American Journal of Gastroenterology reveals that taking proton pump inhibitors (PPIs) twice a day leads to a higher frequency of histological response in patients with eosinophilic esophagitis (EoE) compared to once-daily dosing, even if the total daily dose remains the same.

Since the optimal PPI regimen for EoE remains debatable, researchers conducted a retrospective cohort study to determine the dosing strategy that most effectively achieves histological remission in these patients.

The study involved 305 adult patients (54.6% male; mean age 44.7 years) newly diagnosed with EoE who had not received treatment previously. Patients were prescribed PPIs (omeprazole) at a standard dose (20 mg once daily), medium dose (40 mg once daily or 20 mg twice daily), or high dose (40 mg twice daily) for ≥ 8 weeks. All study participants underwent repeat endoscopic examination 8-12 weeks after starting PPI treatment. The primary endpoint was the histological response to PPI, defined as fewer than 15 eosinophils per high-power field on repeat esophageal biopsy.

The study showed that 42.3% of patients exhibited a histological response to PPI. In the medium-dose group, the frequency of histological response was higher with a dose of 20 mg PPI twice daily compared to a dose of 40 mg PPI once daily (52.8% vs. 10%; P < 0.0001). Compared to the standard PPI dose, higher rates of histological response were associated with taking 20 mg twice daily (adjusted odds ratio [aOR], 6.75; P = 0.0008) and the high dose (aOR 12.8; P < 0.0001). However, this effect was not demonstrated for the 40 mg once-daily dose. Furthermore, the frequency of histological response was comparable between medium and standard PPI doses taken once daily (P = 0.81) and between medium and high PPI doses taken twice daily (P = 0.82).

Therefore, the study demonstrated that the most effective dosing strategy for PPI therapy in EoE may be taking medium daily doses twice daily, with no benefits observed for taking high doses (80 mg/day).