Eosinophilic Esophagitis Is Rarely Continually Symptomatic 10 Years After an Initial Treatment Course in Adults.
Eosinophilic esophagitis
Gastroesophageal reflux
Proton pump inhibitors
Quality of life
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
08
02
2019
accepted:
19
04
2019
pubmed:
9
5
2019
medline:
23
6
2020
entrez:
9
5
2019
Statut:
ppublish
Résumé
Despite its initial description over 25 years ago, there is little known about the course of eosinophilic esophagitis (EoE) after an initial course of medical or dietary treatment. We aim to assess the long-term symptomology and quality of life (QoL) metrics in patients 10 years after initial treatment for eosinophilic esophagitis. Inclusion criteria: single center study of EoE patients diagnosed over 10 years ago with completion of an 18-question structured telephone interview. A cohort of patient's prospectively underwent an esophageal barium exam, esophageal sponge cytology, and evaluation by a esophagologist at greater than 10 years' time since original diagnosis. A total of 54 patients were included in the study. The average age at follow-up was 55.0, with the majority male (64.8%). At the original diagnosis, 62.9% and 37.0% were initially treated with topical steroids and a proton pump inhibitor (PPI), respectively,compared to 59.3% and 7.4% after 10 years, and 7.4% of patients reported a history of dilatations. Only 11.8% noted avoidance of trigger foods, with 62.7% noting an unlimited diet without caution. QoL decrease secondary to EoE was noted to be trivial to minimal in 56.9% of patients, mild in 19.6%, moderate in 15.7% and severe in 7.8%. In the prospective follow-up cohort, the results of telephone survey results matched the direct physician-obtained interview in 88% of cases. Ten years after diagnosis, treated EoE is rarely continually symptomatic, requires mainly PPI-based therapies and is associated with a minimal decrease in QoL scores.
Identifiants
pubmed: 31065898
doi: 10.1007/s10620-019-05636-0
pii: 10.1007/s10620-019-05636-0
doi:
Substances chimiques
Glucocorticoids
0
Proton Pump Inhibitors
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3568-3578Références
Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108:679.
doi: 10.1038/ajg.2013.71
Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128:3.
doi: 10.1016/j.jaci.2011.02.040
Prasad GA, Talley NJ, Romero Y, et al. Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study. Am J Gastroenterol. 2007;102:2627–2632.
doi: 10.1111/j.1572-0241.2007.01512.x
Mackenzie SH, Go M, Chadwick B, et al. Clinical trial: eosinophilic esophagitis in patients presenting with dysphagia: a prospective analysis. Aliment Pharmacol Ter. 2008;28:1140–1146.
doi: 10.1111/j.1365-2036.2008.03795.x
Straumann A. The natural history and complications of eosinophilic esophagitis. Thorac Surg Clin. 2011;21:575–587.
doi: 10.1016/j.thorsurg.2011.09.004
Podboy A, Katzka DA, Enders F, et al. Oesophageal narrowing on barium oesophagram is more common in adult patients with eosinophilic oesophagitis than PPI-responsive oesophageal eosinophilia. Aliment Pharmacol Therap. 2016;. https://doi.org/10.1111/apt.13601 .
doi: 10.1111/apt.13601
Schoepfer AM, Safroneeva E, Bussmann C, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology. 2013;145:1230e2–1236e2.
doi: 10.1053/j.gastro.2013.08.015
Dellon ES, Kim HP, Sperry SL, Rybnicek DA, Woosley JT, Shaheen NJ. A phenotypic analysis shows tha eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc. 2014;79:577e4–585e4.
doi: 10.1016/j.gie.2013.10.027
Straumann A, Spichtin H-P, Grize L, et al. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology. 2003;125:1660–1669.
doi: 10.1053/j.gastro.2003.09.024
Warners M, Nijhuis RAO, De Wijkerslooth LR, et al. The natural course of eosinophilic esophagitis and long-term consequences of undiagnosed disease in a large cohort. Am J Gastroenterol. 2018;113:836–844.
doi: 10.1038/s41395-018-0052-5
Ronkainen J, Talley NJ, Aro P, et al. Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population-based Kalixanda study. Gut. 2007;56:615–620. https://doi.org/10.1136/gut.2006.107714 .
doi: 10.1136/gut.2006.107714
pubmed: 17135307
Mansoor E, Cooper GS. The 2010–2015 prevalence of eosinophilic esophagitis in the United States: a population-based study. Dig Dis Sci. 2016;61:2928–2934. https://doi.org/10.1007/s10620-016-4204-4 .
doi: 10.1007/s10620-016-4204-4
pubmed: 27250980
pmcid: 5021560
Dellon ES. Epidemiology of eosinophilic esophagitis. Gastroenterol Clin N Am. 2014;43:201–218. https://doi.org/10.1016/j.gtc.2014.02.002 .
doi: 10.1016/j.gtc.2014.02.002
Menard-Katcher P, Marks KL, Liacouras CA, et al. The natural history of eosinophilic oesophagitis in the transition from childhood to adulthood. Aliment Pharmacol Ther. 2013;37:114–121.
doi: 10.1111/apt.12119
Dellon ES, Erichsen R, Baron JA, et al. The increasing incidence and prevalence of eosinophilic oesophagitis outpaces changes in endoscopic and biopsy practice: national population-based estimates from Denmark. Aliment Pharmacol Ther. 2015;41:662–670.
doi: 10.1111/apt.13129
Hruz P, Straumann A, Bussmann C, et al. Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland. J Allergy Clin Immunol. 2011;128:1349–1350.
doi: 10.1016/j.jaci.2011.09.013
Straumann A, Simon HU. Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol. 2005;115:418–419.
doi: 10.1016/j.jaci.2004.11.006
Prasad GA, Alexander JA, Schleck CD, et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2009;7:1055–1061.
doi: 10.1016/j.cgh.2009.06.023
Whitney-Miller CL, Katzka D, Furth EE. Eosinophilic esophagitis: a retrospective review of esophageal biopsy specimens from 1992 to 2004 at an adult academic medical center. Am J Clin Pathol. 2009;131:788–792.
doi: 10.1309/AJCPOMPXJFP7EB4P
Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and risk of chronic kidney disease. JAMA Intern Med. 2016;176:238–246. https://doi.org/10.1001/jamainternmed.2015.7193 .
doi: 10.1001/jamainternmed.2015.7193
pubmed: 26752337
pmcid: 4772730
Gomm W, von Holt K, Thomé F, et al. Association of proton pump inhibitors with risk of dementiaa pharmacoepidemiological claims data analysis. JAMA Neurol. 2016;73:410–416. https://doi.org/10.1001/jamaneurol.2015.4791 .
doi: 10.1001/jamaneurol.2015.4791
pubmed: 26882076
Yepuri G, Sukhovershin R, Nazari-Shafti TZ, Petrascheck M, Ghebre YT, Cooke JP. Proton pump inhibitors accelerate endothelial senescence. Circ Res. 2016;118:e36–e42. https://doi.org/10.1161/CIRCRESAHA.116.308807 .
doi: 10.1161/CIRCRESAHA.116.308807
pubmed: 27166251
pmcid: 4902745
Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133:1342–1363.
doi: 10.1053/j.gastro.2007.08.017
Grudell ABM, Alexander JA, Enders FB, et al. Validation of the Mayo Dysphagia Questionnaire. Dis Esophagus. 2007;20:202–205. http://hdl.handle.net/2027.42/71625 .
doi: 10.1111/j.1442-2050.2007.00670.x
Bohm M, Jacobs JW, Gupta A, Gupta S, Wo JM. Most children with eosinophilic esophagitis have a favorable outcome as young adults. Dis Esophagus. 2017;30:1–6. https://doi.org/10.1111/dote.12454 .
doi: 10.1111/dote.12454
pubmed: 26822685
Van Rhijn BD, Weijenborg PW, Verheij J, et al. Proton pump inhibitors partially restore mucosal integrity in patients with proton pump inhibitor-responsive esophageal eosinophilia but not eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2014;12:1815–2300.
doi: 10.1016/j.cgh.2014.02.037
Molina-Infante J, Rivas MD, Hernandez‐Alonso M, et al. Proton pump inhibitor-responsive oesophageal eosinophilia correlates with downregulation of eotaxin-3 and Th2 cytokines overexpression. Aliment Pharmacol Ther. 2014;40:955–965.
doi: 10.1111/apt.12914
Moawad FJ, Wells JM, Johnson RL, et al. Comparison of eotaxin-3 biomarker in patients with eosinophilic oesophagitis, proton pump inhibitor-responsive oesophageal eosinophilia and gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2015;42:231–238.
doi: 10.1111/apt.13258
Kedika RR, Souza RF, Spechler SJ. Potential anti-inflammatory effects of proton pump inhibitors: a review and discussion of the clinical implications. Dig Dis Sci. 2009;54:2312–2317. https://doi.org/10.1007/s10620-009-0951-9 .
doi: 10.1007/s10620-009-0951-9
pubmed: 19714466
pmcid: 3035917
Safroneeva E, Straumann A, Coslovsky M, et al. Symptoms have modest accuracy in detecting endoscopic and histologic remission in adults with eosinophilic esophagitis. Gastroenterology. 2016;150:581–5900000.
doi: 10.1053/j.gastro.2015.11.004
Krishna SG, Kakati BR, Olden KW, et al. Treatment of eosinophilic esophagitis: Is oral viscous budesonide superior to swallowed fluticasone spray? Gastroenterol Hepatol. 2011;7:55–59.
Albert D, Heifert TA, Min SB, et al. Comparisons of fluticasone to budesonide in the treatment of eosinophilic esophagitis. Dig Dis Sci. (Epub ahead of print). https://doi.org/10.1007/s10620-016-4110-9 .
doi: 10.1007/s10620-016-4110-9
Lipka S, Kumar A, Miladinovic B, et al. Systematic review with network meta-analysis: comparative effectiveness of topical steroids vs. PPIs for the treatment of the spectrum of eosinophilic oesophagitis. Aliment Pharmacol Ther. 2016;43:663–673.
doi: 10.1111/apt.13537