A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease

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Su1848 Differences in Presentation of Eosinophilic Esophagitis by Atopic Status, Eosinophilia, and Age of Symptom Onset: An Analysis of Non-Endoscopic Phenotypes

Potential of Blood Eosinophils, Eosinophil-Derived Neurotoxin, and Eotaxin-3 as Biomarkers of Eosinophilic Esophagitis

There are few data exploring modifiable risk factors for eosinophilic esophagitis (EoE). We aimed to determine if smoking, alcohol consumption, and nonsteroidal anti-inflammatory drug (NSAID) use were risk factors for EoE, and to assess their impact on EoE phenotypes and treatment outcomes. We performed a case-control study analyzing data collected from a prospective cohort of adults undergoing upper endoscopy for symptoms of esophageal dysfunction. Incident EoE cases were diagnosed via consensus guidelines. Exposure data were collected via standardized patient questionnaire. Follow-up assessments for cases were made after treatment, with histologic response defined as <15 eosinophils per high-power field (eos/hpf). Exposures were compared between EoE cases and controls, among EoE cases with and without fibrostenosis, and among EoE responders and nonresponders. A total of 115 cases and 225 controls were analyzed. Cases were less likely to have ever smoked cigarettes (23% vs. 47%, P<0.001) or currently use NSAIDs (17% vs. 40%, P<0.001) compared to controls. These relations persisted after multivariate analysis. Although alcohol use was more common among cases (75% vs. 51%, P<0.001), the effect was abrogated after multivariate analysis. Smoking, alcohol, and NSAID use were not associated with the fibrostenotic phenotype. There was a trend toward improved histologic response among EoE patients concomitantly using NSAIDs (87% vs. 63%, P=0.08; aOR 6.97 (95% CI: 0.81-60.3). In conclusion, NSAID and smoking were inversely associated with EoE compared to endoscopy-based controls. Alcohol use was more prevalent in the EoE cases, although not an independent risk factor. Concomitant NSAID use may improve treatment response and is worthy of future study.

Eosinophilic esophagitis: New insights into an emerging disease

This Month in Gastroenterology

Pilot Study of Radiological Assessment of Short-Term Corticosteroid Therapy on Esophageal Distensibility in Eosinophilic Esophagitis (EoE)

Time Trends in Foreign Body Impactions in the Esophagus: What is the Impact of the Increasing Prevalence of Eosinophilic Esophagitis?

INTRODUCTION: The prevalence of eosinophilic esophagitis (EoE) is estimated to be 0.5-1 in 1000 and is increasing across the United States. New cases of EoE are being diagnosed, in part due to increased awareness of the disease. Recent epidemiological studies have demonstrated that the natural course of EoE is a progressive transformation from an inflammatory to a complicated fibrostenotic disease. Increased prevalence has driven sentiment for an evidence-based management algorithm for EoE. We identified trends in hospital admissions for complicated EoE demonstrated by food impactions/foreign bodies (FI/FB) and highlight gaps in the current management. METHODS: This is a retrospective cohort study using the 2011-2014 Nationwide Inpatient Sample (NIS) utilizing International Classification of Diseases, 9th Revision. Study included all patients above age 18 with principal or secondary discharge diagnoses of FI/FB. Primary outcomes were trends of the FI/FB cohort with associated diagnoses of EoE. Secondary outcomes included length of stay (LOS). Proportions were compared using fisher’s exact test and continuous variables using student t-test. Multivariable and Poisson regression was performed for LOS and hospitalization charges. RESULTS: From 2011 to 2014, the number of FI/FB admissions analyzed were 11,041, 10,730, 10,460, and 9,925, respectively. EoE was a principle diagnosis in 73.2%, 86.4%, 86.8% and 92.6% of these admissions, respectively. The average LOS for FI/FB admissions for patients without EoE (no EoE FI/FB) was 4.11 days; average LOS for FI/FB admissions for patients with EoE (EoE FI/FB) was 0.95 days (P &lt; 0.001). Mean age of EoE FI/FB was 30.23 years vs 55.32 years in no EoE FI/FB (P &lt; 0.001). 90.02% of EoE FI/FB were Caucasian, 3.66% African American and 4.48% Hispanic, compared to 71.78% Caucasian, 11.47% African American, and 11.08% Hispanic in no EoE FI/FB. 3.33% of EoE FI/FB underwent EGD with biopsies compared to 0.64% of no EoE FI/FB (P = 0.0002). Cost of admission for EoE FI/FB was $16,606.80 vs $38,282.34 in no EoE FI/FB (P &lt; 0.001). CONCLUSION: EoE is the most common underlying etiology in cases of food impaction. This study suggests that progressive, complicated EoE is also growing in incidence. Increased admissions rates, low LOS and low numbers of patients undergoing EGD with biopsies suggests that EoE is not being appropriately surveilled nor directly addressed with patients in terms of highlighting its long-term complications and importance of implementing a management strategy.

Endoscopic features of eosinophilic esophagitis (EoE) are variable with at least 2 phenotypes. The goal of this study was to classify adult EoE patients based on esophageal phenotype and diameter, and assess an association between demographical and clinical histories to define EoE phenotypes and overall disease progression. All consecutive patients with a confirmed diagnosis of EoE from 1988 to 2013 treated at University of South Florida were included. Patients were grouped into inflammatory or fibrostenotic phenotype, and further characterized by esophageal diameter: group 1 (6 to 9.9 mm), group 2 (10 to 16.9 mm), and group 3 (>17 mm-control). Significance level was set at 5%. Sixty-four adult patients met inclusion criteria. Sixty-one percent of patients (39/64) were defined as fibrostenotic and 39% (25/64) as inflammatory phenotype. There was a significant difference in mean time of delayed diagnosis in patients with <10 mm esophageal diameter (14.8 y) and patients with a diameter of 10 to 16.9 mm (11.1 y) compared with patients with an esophageal diameter of ≥17 mm (5 y); P=0.002 and 0.006, respectively. Patients on aspirin with delayed diagnosis (>7 y) were significantly more likely to present with strictures (<10 mm) compared with nonaspirin users [odds ratio (OR=7.0; 95% confidence interval (CI), 7.2-31.3; P=0.008]. Similar results were found with non-steroid anti-inflammatory drugs, smoking, and alcohol (OR=6.4; 95% CI, 1.6-26.4; P=0.01, OR=5.2; 95% CI, 1.4-20.1; P=0.02, and OR=6.4; 95% CI, 1.6-26.0; P=0.009), respectively. In our US population, a delay in diagnosis was shown to be associated with stricture formation in EoE confirming the Swiss experience. The results show the importance of reducing the diagnostic delay in EoE as there appears to be progression to fibrosis over time, aggravated by common medications and social habits.

Esophageal dilation in eosinophilic esophagitis: safety and predictors of clinical response and complications

Prior to the consensus guideline conference in 2007, eosinophilic esophagitis (EoE) was uncommon dominated by the fibrostenotic phenotype, but over the past decade has become a common cause of dysphagia with more inflammatory phenotypes diagnosed. We assessed the impact of guideline definitions on the characteristics of EoE phenotypes over the past 26 years at our institution. We reviewed the electronic health record of 75 consecutive patients meeting guideline definition EoE from 1/1988 to 5/2014. We separated groups based on 5-year intervals of diagnosis and phenotype. For continuous data, results were summarized as mean difference and standard deviation with 95 % confidence intervals. Five groups based on 5-year intervals of diagnosis were identified: group 1-1988-1993 (n = 7), group 2-1994-1999 (n = 7), group 3-2000-2005 (n = 4), group 4-2006-2011 (n = 35), and group 5-2012-2014 (n = 22). Prior to 2000, all patients were diagnosed with fibrostenotic EoE. After the initial 2007 guideline conference, inflammatory EoE has predominated with only one-third diagnosed with fibrostenotic EoE. Prior to 2011, only two were diagnosed with PPI-REE. In the last 3 years, 8 out of 22 patients (32 %) had PPI-REE. Overall, 8 out of 10 (80 %) PPI-REE were the inflammatory phenotype. When comparing pre- (n = 18) and post (n = 57)-consensus definitions, there was a significant difference between age of diagnosis (30.710.2 vs. 41.3 ± 14.3; p = 0.001), age of symptom onset (18.4 +/15.2 vs. 32.4 ± 15.5), and initial esophageal diameter (10.5 ± 2.7 vs. 14.3 ± 4.2; p < 0.0001), respectively. Fibrostenotic EoE has steadily decreased, and inflammatory EoE is now the most recognized form. Across our 26-year experience, there was a decrease in delay in diagnosis and severity of esophageal stricture. The pivotal change occurred around 2007 corresponding to the first EoE guideline emphasizing the impact and importance of early detection of disease.

Eosinophilic Esophagitis: A Prevalent Disease in the United States That Affects All Age Groups

Onset of eosinophilic esophagitis during a clinical trial program of oral immunotherapy for peanut allergy

Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis