Journal Article

Proton pump inhibitors and suppression of duodenal eosinophilia in functional dyspepsia

Potter, Michael D E, Jones, Michael P, Wood, Nicola K, Walker, Marjorie M, Talley, Nicholas J

2019

Overview

Correspondence to Dr Michael D E Potter, Faculty of Health and Medicine, University of Newcastle, Callaghan NSW 2305, Australia; [e-mail] We read with interest the study by Molina-Infante et al 1 regarding proton pump inhibitor (PPI) responsive oesophageal eosinophilia. The authors emphasise that the benefit of PPI therapy may be secondary to anti-inflammatory effects (blocking of STAT 6) rather than antisecretory properties, which raises the question whether PPI therapy may be beneficial in other eosinophilic disease of the gastrointestinal tract. FD has been linked with subtle duodenal eosinophilia in several studies, with a mean eosinophil count of 49±22 (mm2±SD) in the second part of the duodenum (D2) significantly associated with the diagnosis.3 PPIs are efficacious in the treatment of FD, and based on several randomised controlled trials, is recommended as first-line therapy in those who are Helicobacter pylori negative, or in those whom symptoms persist following H. pylori eradication.4 PPIs are known to have a number of novel effects that cannot be explained simply by a reduction in acid secretion, including suppression of the T helper 2-cytokine-stimulated expression of the eosinophil chemoattractant eotaxin.5 We hypothesised that PPIs may exert a therapeutic effect in FD via suppression of duodenal eosinophils and that a reduction in both symptom scores and duodenal eosinophils would be observed in patients with FD on PPI therapy.

• Publisher: BMJ Publishing Group LTD
• Subject: Blood diseases / Clinical trials / Duodenum / Dyspepsia / Endoscopy / Eosinophilia / Eotaxin / Esophagus / Gastrointestinal tract / Helicobacter pylori / Inflammation / Leukocytes (eosinophilic) / Pain / Patients / Proton pump inhibitors / Protons