PD03.08. Impact of Proton Pump Inhibitor Treatment on T-Cell Subgroups in Eosinophilic Esophagitis

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ID: 326020
2026
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Ranked #199 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Eosinophilic Esophagitis Background Eosinophilic esophagitis (EoE) is a chronic, allergy-related inflammatory disease of the esophagus causing dysphagia and food impaction. Untreated, it may lead to fibrosis. This study investigated changes in T-cell subgroups before and after proton pump inhibitor therapy and evaluated blood-based T-cell markers as less invasive indicators of treatment response. Methods Blood samples from patients with EoE (n=17; 87% men, 53% allergic) were collected before and after 12 weeks of proton pump inhibitor therapy (omeprazole 20 mg twice daily) and compared with healthy controls. Samples were analyzed by CyTOF using an antibody panel covering major T-cell populations. Data was processed with FlowSOM for cluster identification and Opt-SNE for dimensionality reduction and visualization. Esophageal biopsies were evaluated for eosinophils/HPF and by the Eosinophilic Esophagitis Histologic Scoring System (EoE-HSS). Endoscopic findings were scored with EREFS, and symptoms assessed using the Eosinophilic Esophagitis Activity Index (EEsaI) and the Watson Dysphagia Scale (WDS). Results Twelve patients (71%) responded to PPI-treatment and attained <15 peak eosinophils/HPF, whereas five patients didn't. In the responder group, eosinophils/HPF decreased from a mean of 45 (range 16–108) before treatment to 2 (range 0–9) after treatment. EoE-HSS grade scores fell from 0.6 to 0.2, and EoE-HSS stage scores declined from 0.8 to 0.4. Unsupervised clustering identified key T-cell populations altered by treatment, including Th2 central memory CD4+ T cells, CD8+ terminal effector and naïve subsets. Successful PPI-therapy was associated with expansion of FOXP3+ T cells and reduction of cytotoxic CD56+ CD8+ T cells, which persisted in non-responders. Naïve CD4+ and CD8+ T-cell populations decreased after treatment regardless of clinical outcome. Notably, peripheral CD4+ T-cell counts correlated with histologic disease severity (EoE-HSS), while eosinophil density did not. Successful treatment reduced EREFS from 3 to 1.9, EEsaI from 45 to 31, and WDS from 18 to 14. Conclusion The current study shows that T cells, in addition to eosinophils, play an active role in the inflammation in eosinophilic esophagitis. The results contribute to ongoing efforts to establish biomarkers capable of assessing disease progression and therapeutic response in EoE and may provide insights into its pathophysiology.
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Authors Helen Larsson, Christine Lingblom, John Plate
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.094
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.094/70760303/doag077.094.pdf
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