Food-induced Immediate Response of the Esophagus - a newly identified Syndrome in Patients with Eosinophilic Esophagitis.

Biedermann, Luc; Holbreich, Mark; Atkins, Dan; Chehade, Mirna; Dellon, Evan S; Furuta, Glenn T; Hirano, Ikuo; Gonsalves, Nirmala; Greuter, Thomas; Katzka, David A; De Rooij, Willemijn; Safroneeva, Ekaterina; Schoepfer, Alain; Schreiner, Philipp; Simon, Dagmar; Simon, Hans Uwe; Warners, Marijn; Bredenoord, Albert-Jan; Straumann, Alex (2021). Food-induced Immediate Response of the Esophagus - a newly identified Syndrome in Patients with Eosinophilic Esophagitis. Allergy, 76(1), pp. 339-347. Wiley-Blackwell 10.1111/all.14495

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BACKGROUND

Dysphagia is the main symptom of adult EoE. We describe a novel syndrome, referred to as "Food-induced Immediate Response of the Esophagus" (FIRE), observed in EoE patients.

METHODS

FIRE is an unpleasant/painful sensation, unrelated to dysphagia, occurring immediately after esophageal contact with specific foods. EoE experts were surveyed to estimate the prevalence of FIRE, characterize symptoms and identify food triggers. We also surveyed a large group of EoE patients enrolled in the Swiss EoE Cohort Study (SEECS) for FIRE RESULTS: Response rates were 82% (47/57) for the expert- and 65% (239/368) for the patient-survey, respectively. Almost 90% of EoE experts had observed the FIRE symptom-complex in their patients. Forty percent of EoE patients reported experiencing FIRE, more commonly in patients who developed EoE symptoms at a younger age (mean age of 46.4 vs. 54.1 years without FIRE; p<0.01) and in those with high allergic comorbidity. FIRE symptoms included narrowing, burning, choking and pressure in the esophagus appearing within 5 minutes of ingesting a provoking food that lasted less than 2 hours. Symptom severity rated a median 7 points on a visual analogue scale from 1-10. Fresh fruits/vegetables and wine were the most frequent triggers. Endoscopic food removal was significantly more commonly reported in male patients with vs. without FIRE (44.3% vs. 27.6%; p = 0.03).

CONCLUSIONS

FIRE is a novel syndrome frequently reported in EoE patients, characterized by an intense, unpleasant/painful sensation occurring rapidly and reproducibly in 40% of surveyed EoE patients after esophageal contact with specific foods.

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