Proton-pump inhibitors (PPIs) are not approved for the treatment of EoE. Treatment with PPIs leads to clinical and histological remission some adult and paediatric patients.¹ The effects of PPIs are likely due to acid-independent inhibition of eotaxin-3, a key cytokine in the pathogenesis of EoE.² A meta-analysis of 33 studies on the effects of PPIs in the treatment of EoE patients revealed histological remission in 50.5% of subjects and symptom improvement in 60.8%. A higher response tended to be seen with higher PPI doses (standard dose 2x versus 1x daily) and in patients with pathologic pH metrics. However, the authors of the meta-analysis specifically noted the poor quality of the evidence (e.g., no placebo-controlled studies), heterogeneity and significant publication bias.³ A recent prospective study reported clinical and histological remission in only 33% of patients using high-dose PPI therapy with 2 x 40 mg omeprazole/day for 8 weeks. Following the step-down phase to 20 mg omeprazole/day, the remission rate dropped to 12% (see fig. 2).⁴ There are still no placebo-controlled studies on the use of PPI to treat EoE, rendering it impossible to quantify their general benefit and to formulate a clear recommendation on the length of treatment. Moreover, PPI are currently not approved for the treatment of EoE.