Dose May Matter: CYP2C19 Genotype and PPI Response in Pediatric Eosinophilic Esophagitis.

Bose, Paroma; Umeweni, Chizoba N; Perkins, Anthony; Jensen, Elizabeth T; Dellon, Evan S; Muir, Amanda B; Gupta, Sandeep K · Am J Gastroenterol · 2026

prospective_cohort · Level II

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Abstract

Little is known about the effect of proton pump inhibitor (PPI) metabolism, based on CYP2C19 genotype, on treatment response in pediatric eosinophilic esophagitis (EoE). We conducted a cohort study of pediatric subjects with active histologic EoE treated with PPI therapy. Whole blood samples were tested for CYP2C19 genotype. Among subjects prescribed high PPI dose > 1mg/kg/day, intermediate/slow PPI metabolizers were significantly more likely to have histologic response to PPI therapy compared to normal and rapid PPI metabolizers. No ultra-rapid metabolizers responded to PPI therapy. Knowing CYP2C19 genotype may optimize PPI dose for the treatment of EoE in individual patients.