Research Suggests Proton Pump Inhibitors May Help Limit Fibrosis in Eosinophilic Esophagitis

November 11, 2026

Key Takeaways

Proton pump inhibitors (PPIs) are known to reduce acid and inflammation. Research published in The Journal of Allergy and Clinical Immunology, with Phoenix Children’s pediatric gastroenterologist Colby S. Sharlin, MD, as first author, suggests they may also help limit scarring (fibrosis) in eosinophilic esophagitis (EoE).
Fibrosis is the main driver of complications in EoE. Untreated, it may progress to an esophageal stricture, a narrowing that can lower quality of life and, in some cases, lead to procedures such as esophageal dilation (stretching the narrowed area).
Choking episodes and food getting stuck in the chest (food impaction) are signs that fibrosis may already be a concern.

More Than an Antacid

PPIs are often used as an initial treatment for pediatric EoE. Their acid-reducing and anti-inflammatory properties make them an effective treatment for some patients. Recent research suggests PPI therapy may also help limit esophageal fibrosis, the scarring that drives the disease’s complications.

Colby S. Sharlin, MD, a pediatric gastroenterologist at Phoenix Children’s, is first author of the study. He said the findings add to the existing evidence that PPIs are not just an antacid medication. Conducted in the Shoda Lab at Cincinnati Children’s Hospital Medical Center, the research builds on what is known about their anti-inflammatory properties and found anti-fibrotic properties as well, both in groups of patients (clinical cohorts) and in basic science experiments.

Why Esophageal Fibrosis Matters

“Fibrosis or scarring is the main driver of complications in EoE,” said Dr. Sharlin.

When EoE is untreated, scarring may progress. That can lead to strictures, or narrowing of the esophagus. Strictures can mean poorer quality of life and, in some cases, more involved procedures such as esophageal dilations.

“Given that strictures are the most severe manifestation of EoE, it is important to prevent progressive scarring in this chronic disease with an effective treatment plan,” he said.

Signs That Fibrosis May Already Be a Concern

Symptoms: choking or food impactions, such as food getting stuck in the chest
On endoscopy: visible narrowing, strictures and rings
On biopsy: early scarring may not be visible during endoscopy, but biopsies can identify changes seen only under the microscope

Choosing and Monitoring PPI Therapy

“We utilize shared decision-making when deciding on EoE treatment approaches at Phoenix Children’s and in our multidisciplinary Eosinophilic GI Disorders clinic,” said Dr. Sharlin.

Before choosing a PPI, the team reviews each patient’s:

Medical history
Nutritional status
Developmental status, including the ability to take medications by mouth

Once a treatment plan is in place, follow-up evaluation is needed to make sure the treatment is working. This is typically done with a sedated upper endoscopy. Phoenix Children’s also offers two sedation-free options:

Unsedated transnasal endoscopy: A thin scope is passed through the nose while the child is awake.
Esophageal string test: The child swallows a capsule with a thin string attached. The string collects a sample from the esophagus to check for EoE inflammation.

Clinical Implications for Your Practice

PPIs are not just an antacid. Evidence supports their anti-inflammatory properties, and this research suggests they may help limit scarring as well.
In a child with EoE, choking or food getting stuck may signal fibrosis.
After treatment starts, a follow-up evaluation is needed to confirm that it is working.

What Comes Next

Much of the current focus in EoE is on new biologic therapies. Dr. Sharlin said it is still important to fully understand where currently available traditional therapies, including PPIs, fit in treatment. He said future research should explore combination therapies and advance precision medicine strategies to make the best use of PPIs for therapeutic benefit and safety in children and adults with EoE.

EoE Care at Phoenix Children’s

The multidisciplinary Eosinophilic Gastrointestinal Disorders (EGID) Clinic at Phoenix Children’s brings gastroenterologists, allergists and registered dietitians together at the same visit to treat eosinophilic gastrointestinal disorders along with related allergic and GI conditions.

Phoenix Children’s physicians are engaged in EGID research at all levels, from basic science to clinical and translational research. Dr. Sharlin said the team is recognized nationally as a leader in EGID clinical trials.

How to Refer

The EGID Clinic is open to any patient with an existing diagnosis. Many referrals come from Phoenix Children’s gastroenterologists and allergists, but the team also works with community providers who want additional expert guidance, collaboration or access to sedation-free disease monitoring for their patients. Care coordination team members work with patients, families and referring providers to prepare for the visit and gather the needed medical records ahead of time.

To refer a patient, call 602-933-0940 or submit a referral online.

About the Author

Colby S. Sharlin, MD
Pediatric Gastroenterologist, Phoenix Children’s

Dr. Sharlin is a pediatric gastroenterologist in the Division of Gastroenterology and GI Surgery at Phoenix Children’s, with a particular focus on allergy and eosinophilic gastrointestinal disorders. He earned his medical degree at Creighton University School of Medicine in Phoenix, completed his pediatrics residency at Phoenix Children’s and completed a fellowship in pediatric gastroenterology, hepatology and nutrition at Cincinnati Children’s Hospital. He also holds a graduate certificate in clinical and translational research from the University of Cincinnati. He is board-certified in pediatrics by the American Board of Pediatrics and is an assistant clinical professor of child health at the University of Arizona College of Medicine – Phoenix.

The research referenced in these materials was conducted in the Shoda Lab at Cincinnati Children’s Hospital Medical Center.

Sources

Sharlin CS, Yamada S, et al. Effects of proton pump inhibitors on remodeling and fibrosis in eosinophilic esophagitis. The Journal of Allergy and Clinical Immunology. 2026;157(5):1114-1126. PubMed ID 41765110.