Long-Lasting Dissociation of Esophageal Eosinophilia and Symptoms Following Dilation in Adults with Eosinophilic Esophagitis.

Safroneeva, Ekaterina; Pan, Zhaoxing; King, Eileen; Martin, Lisa J; Collins, Margaret H; Yang, Guang-Yu; Capocelli, Kelley E; Arva, Nicoleta C; Abonia, J Pablo; Atkins, Dan; Bonis, Peter A; Dellon, Evan S; Falk, Gary W; Gonsalves, Nirmala; Gupta, Sandeep K; Hirano, Ikuo; Leung, John; Menard-Katcher, Paul A; Mukkada, Vincent A; Schoepfer, Alain M; ... (2021). Long-Lasting Dissociation of Esophageal Eosinophilia and Symptoms Following Dilation in Adults with Eosinophilic Esophagitis. (In Press). Clinical gastroenterology and hepatology Elsevier 10.1016/j.cgh.2021.05.049

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BACKGROUND AND AIMS

Esophageal dilation improves dysphagia but not inflammation in eosinophilic esophagitis (EoE) patients. We investigated if dilation modifies the association between symptoms and esophageal eosinophil count (eos/hpf).

METHODS

Adults enrolled in a multisite, prospective Consortium of Gastrointestinal Eosinophilic Disease Researchers OMEGA observational study (NCT02523118) completed the symptom-based EoE activity index (EEsAI) patient-reported outcome instrument and underwent endoscopy with biopsies. Patients were stratified based on dilation status as absent, performed ≤1 and >1 year before endoscopy. Assessments included Spearman's correlations of the relationship between symptoms and eos/hpf and linear regression with EEsAI as the outcome, eos/hpf as predictor, and interaction for dilation and eos/hpf.

RESULTS

Amongst 100 patients (n=61 male, median age 37 years), 15 and 40 patients underwent dilation ≤1 year and >1 year before index endoscopy, respectively. In non-dilated patients, association between eos/hpf and symptoms was moderate (Rho=0.49, p-value<0.001); for 10 eos/hpf increase, the predicted EEsAI increased by 2.69 (p-value=0.002). In patients dilated ≤1 and >1 year before index endoscopy, this association was abolished (Rho=-0.38, p-value=0.157 for ≤1 year and Rho=0.02, p-value=0.883 >1 year); for 10 eos/hpf increase, the predicted EEsAI changed by -1.64 (p-value=0.183) and 0.78 (p-value=0.494), respectively). Dilation modifies association between symptoms and eos/hpf (p-value=0.005 and p-value=0.187 for interaction terms of eos/hpf and dilation ≤1 year and >1 year before index endoscopy, respectively).

CONCLUSION

In non-dilated EoE adults, eos/hpf correlates modestly with symptoms; this correlation was no longer appreciated in dilated patients, and the dilation effects lasted longer than one year. Dilation status should be considered in studies evaluating EoE treatment and for clinical follow-up.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Safroneeva, Ekaterina

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1542-3565

Publisher:

Elsevier

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

08 Jun 2021 15:39

Last Modified:

10 Jun 2021 06:29

Publisher DOI:

10.1016/j.cgh.2021.05.049

PubMed ID:

34062314

Uncontrolled Keywords:

dysphagia effect modification endoscopic reference score eosinophilic esophagitis histologic scoring system eosinophilic esophagitis-specific quality of life in adults pain when swallowing

BORIS DOI:

10.48350/156748

URI:

https://boris.unibe.ch/id/eprint/156748

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