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

ABSTRACT: Phenotypes of eosinophilic esophagitis (EoE) are not well-characterized.To describe clinical features of patients with EoE with predefined phenotypes, determine predictors of these phenotypes, and make inferences about the natural history of EoE.Retrospective study.Tertiary-care center.Incident EoE cases from 2001 to 2011 that met consensus diagnostic guidelines.Review of records.Endoscopic phenotypes, including fibrostenotic, inflammatory, or mixed. Other groups of clinical characteristics examined included atopy, level of esophageal eosinophilia, and age of symptom onset. Multinomial logistic regression assessed predictors of phenotype status.Of 379 cases of EoE identified, there were no significant phenotypic differences by atopic status or level of eosinophilia. Those with the inflammatory phenotype were more likely to be younger than those with mixed or fibrostenotic (13 vs 29 vs 39 years, respectively; P < .001) and less likely to have dysphagia, food impaction, and esophageal dilation (P < .001 for all). The mean symptom length before diagnosis was shorter for inflammatory (5 vs 8 vs 8 years; P = .02). After multivariate analysis, age and dysphagia independently predicted phenotype. The odds ratio (OR) for fibrostenosis for each 10-year increase in age was 2.1 (95% CI, 1.7-2.7). The OR for dysphagia was 7.0 (95% CI, 2.6-18.6).Retrospective, single-center study.In this large EoE cohort, the likelihood of fibrostenotic disease increased markedly with age. For every 10-year increase in age, the odds of having a fibrostenotic EoE phenotype more than doubled. This association suggests that the natural history of EoE is a progression from an inflammatory to a fibrostenotic disease.

SUBMITTER: Dellon ES

PROVIDER: S-EPMC4599711 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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

Dellon Evan S ES Kim Hannah P HP Sperry Sarah L W SL Rybnicek David A DA Woosley John T JT Shaheen Nicholas J NJ

Gastrointestinal endoscopy 20131123 4

<h4>Background</h4>Phenotypes of eosinophilic esophagitis (EoE) are not well-characterized.<h4>Objective</h4>To describe clinical features of patients with EoE with predefined phenotypes, determine predictors of these phenotypes, and make inferences about the natural history of EoE.<h4>Design</h4>Retrospective study.<h4>Setting</h4>Tertiary-care center.<h4>Patients</h4>Incident EoE cases from 2001 to 2011 that met consensus diagnostic guidelines.<h4>Intervention</h4>Review of records.<h4>Main ou ...[more]

PMID: 24275329

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Project description:ObjectivesEosinophilic esophagitis (EoE) is a chronic inflammatory condition that causes esophageal remodeling and stricture formation. We compared the clinical course of symptoms, endoscopic findings, histology, and changes in phenotype over time in EoE patients with inflammatory and fibrostenotic phenotypes.MethodsData were obtained from EoE patients from three medical centers and followed prospectively. Endoscopic features and histology from index and follow-up endoscopies were recorded. Behavior was classified as inflammatory if endoscopic findings demonstrated furrows or white plaques and as fibrostenotic if endoscopic findings included fixed rings or strictures.ResultsTwo hundred and fifty-six EoE patients were included in the analysis. The mean age was 32±18 years, 25% of patients were <18 years, 89% of patients were Caucasians, and 74% of patients were male. The mean duration of symptoms before diagnosis was 6.8±7.2 years with a follow-up of 1.7±1.9 years (maximum follow-up of 12 years). Fifty-four percent of patients presented with fibrostenotic EoE, whereas 46% presented with inflammatory EoE. Patients with inflammatory disease were younger than those with fibrostenotic disease (24±19 vs. 39±15 years, P<0.001). Patients with fibrostenotic disease had a longer duration of symptoms than those with inflammatory disease (8.1±7.7 vs. 5.3±6.3 years, P=0.002). Over the study period, 47 (18%) had remission of inflammatory EoE, 68 (27%) continued to have inflammatory disease, 74 (29%) continued to have fibrostenotic disease, 65 (25%) fibrostenotic patients had regression of fibrosis, and 2 patients (1%) progressed from inflammatory disease to fibrostenotic disease. Patients who had regression from their fibrostenosis were more likely than patients who continued to demonstrate fibrostenosis to have a decrease in proximal (54% vs. 32%, P<0.001) and distal (70% vs. 38%, P<0.001) eosinophilia.ConclusionsMost EoE patients maintained their phenotype or had an improvement with <1% progressing from inflammatory to fibrostenosis. This suggests that early therapeutic strategies aimed at controlling inflammation may interrupt, decrease, or prevent the remodeling fibrosis in EoE.

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

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

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