OBJECTIVES: Eosinophilic esophagitis (EoE) is an increasingly recognized condition both in children and adults. The aim of the present study was to review the available evidence regarding EoE in adults and adolescents associated with proton pump inhibitors (PPI) and topical steroids (TCS) treatment.

METHODS: PubMed, Embase and Cochrane Library were searched for English-language articles up to May 11, 2023. Search strings were constructed based on the following PICOS criteria. Population: EoE patients ≥12 years; Intervention: PPI or TCS in monotherapy or in combination; Comparators: any treatment; Outcomes: efficacy (clinical, histologic and endoscopic response, symptoms reduction, relapse, response duration, esophageal dilatation), safety (any treatment related adverse event [TRAE]), quality of life and changing in treatment management dynamics.

RESULTS: After screened a total of 1062 articles, we included 116 studies that met inclusion criteria. PPI and TCS efficacy were reported in 37 (45%) and 62 (76%) studies, respectively. The main outcome was histologic response (90%), followed by clinical (55%) and endoscopic (27%). Histologic response was defined as proportion of patients achieving <15 eosinophils per high-power field (eos/hpf) in almost all studies (86%); more restrictive thresholds define as <6 and <1 eos/hpf were used in 30% and 19% of studies, respectively. TRAE were reported in 23 studies (83% TCS, 13% PPI and 17% related to esophageal dilation). Quality of life was measured in 13 studies mainly using EoE-QoL-A score (N=7), only in 1 study the EQ-5D questionnaire was used. Finally, the majority of included studies were conducted before 2018 AGREE international consensus conference, hence PPI-responsive eosinophilic esophagitis patients were investigated in less than one third of the papers.

CONCLUSIONS: Efficacy of PPI and TCS in EoE patients ≥12 years has been deeply investigated in published literature while few information are available on quality of life and adverse events associated to corticosteroids therapy.