Mo1191 The GerdQ Questionnaire Distinguishes Proton Pump Inhibitor-Responsive Esophageal Eosinophilia From Eosinophilic Esophagitis Patients

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder.A subset of patients with esophageal eosinophilia responds to proton-pump inhibitor (PPI) therapy and has been termed PPI-responsive esophageal eosinophilia (PPI-REE).Both disorders are known to be associated with allergic conditions.The seasonal variation observed in some studies of EoE suggest a possible role for environmental allergens.Defining the distinct environmental allergy profile of patients with EoE compared to PPI-REE may help define pathogenesis and potentially guide therapy.Aim: To compare the prevalence of reaction to environmental allergens of EoE vs PPI-REE on allergy skin testing.Methods: This was a retrospective cohort study of patients diagnosed with esophageal eosinophilia (>15 eos/hpf) on mucosal biopsies from upper endoscopy (EGD) at a tertiary care center from 5/2006-7/ 2015.All included patients underwent a high-dose PPI trial ‡8 weeks, and were classified based on biopsies from post-PPI trial repeat EGD into EoE (>15 eos/hpf) vs PPI-REE (<15 eos/hpf).Allergy skin testing was performed for a standardized battery of food and environmental antigens.Fisher-exact test for binary variables and student t-test for continuous variables were used to assess differences between cohorts.Multivariate analysis was performed using forward stepwise logistic regression.Results: 121 patients (49% EoE, 51%PPI-REE) were diagnosed with esophageal eosinophilia and 33 (27%) patients underwent allergy skin testing.Of the standard environmental antigens, D. pteronyssinus (86% vs 50%, p=0.04), oak (90% vs 42%, p=.006), birch (89% vs 42%, p=.012), grass (79% vs 42%, p=0.035), and hormodendrum mold (89% vs 33%, p=.002) were significantly more prevalent in EoE vs PPI-REE.(Table 1).When categorizing environmental allergens into weed pollen, tree pollen, mold, and dust mites, only tree pollen was significantly more prevalent in EoE compared to PPI-REE [90% vs 58%, p=0.04].On multivariate analysis, hormodendrum mold was the only independent positive predictor for EoE [OR=16, p=0.002].By group, tree pollen was the only independent positive predictor for EoE [OR=6.43,p=.04].There were no significant differences in food allergens between EoE and PPI-REE.Conclusion: Selected environmental allergens are more prevalent among patients with EoE compared to PPI-REE.These include pollens (tree, grass and weed) which peak between Spring and Fall and may help explain the seasonal variation in severity of disease.Given the otherwise similar clinical, endoscopic and food allergy profiles between EoE and PPI-REE, our data suggest that environmental allergens may play a more significant role in the pathogenesis of EoE compared with PPI-REE.Table 1.