BACKGROUND: The optimal proton pump inhibitor (PPI) regimen for eosinophilic esophagitis (EoE) is unclear. We compared histologic response rates of different dosing combinations.

METHODS: 305 newly-diagnosed EoE patients received standard (omeprazole 20mg daily), once-daily moderate (40mg daily), twice-daily moderate (20mg twice daily), or high (40mg twice daily) dose PPI for ≥8 weeks.

RESULTS: 42.3% achieved histologic response to PPI, with higher rates for twice-daily (moderate:52.8%/high:54.3%) than once-daily (standard:11.8%/moderate:10%) dosing (p<0.0001). On multivariable analysis, twice-daily moderate (aOR:6.75, CI:2.53-18.0,p=0.0008) and high (aOR:12.8, CI:4.69-34.8,p<0.0001) doses independently predicted histologic response.

CONCLUSION: Twice-daily PPI is associated with higher EoE histologic response rates than once-daily regimen.