In this video, Spencer discusses the use of proton pump inhibitors (PPIs) to treat eosinophilic esophagitis (EoE) in pediatric patients. She notes that dietary therapy can be easier in young children since they are often already on specialized formula. PPIs may not be relied upon as heavily in infants since formula changes are socially acceptable and impactful. However, PPIs are very safe and effective in children.

The main safety concerns with PPIs are an increased risk of gastrointestinal infections in adults because stomach acid helps kill bacteria. Also in adults, there is a risk of bone breaks. However, Spencer states these risks have not been observed in pediatric populations. When using PPIs for EoE, the goal is to reach the minimal effective dose. This requires checking for the absence of eosinophils via repeated endoscopies while tapering the PPI dose over months. Many caregivers and patients find the frequent endoscopies frustrating.

Spencer discusses some alternatives under investigation to replace endoscopy for monitoring EoE, including transnasal endoscopy and devices to obtain esophageal samples less invasively. She notes that a blood test would be impactful if it could provide similar information to endoscopy. In conclusion, she emphasizes the importance of a multidisciplinary approach and providing patients options, such as transnasal endoscopy, which many centers now offer.

Video synopsis is AI-generated and reviewed by AJMC^® editorial staff.