Background and Aims

Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus. Its prevalence has been increasing steadily over the past 3 decades. The prognosis of patients with EoE presenting with severe esophageal strictures is poorly understood. The aim of this study was to describe the clinical outcomes of patients with EoE with severe strictures and identify factors associated with a greater likelihood of improvement in esophageal diameter.

Methods

This study is a retrospective chart review of patients with EoE with severe stricture, defined as an esophageal diameter of 10 mm or less at one point in their disease course. Each patient’s clinical course was followed during standard-of-care follow-up with medical or dietary therapy in conjunction with repeated esophageal dilation. Multivariate regression analysis was performed to determine which variables are associated with endoscopic response, defined by an improvement in esophageal diameter to 13 mm and to 15 mm.

Results

From a cohort of 1091 adults with EoE, severe strictures were identified in 66 patients (7%). Of the 66 patients, 59 (89%) achieved an esophageal diameter of ≥13 mm and 43 (65%) achieved ≥15 mm. Initial diameter (odds ratio, 1.58; 95% confidence interval, 1.06-2.35; P = .025) and histologic remission (odds ratio, 34.97; 95% confidence interval, 6.45-189.49; P < .0001) were significantly associated with achieving a diameter ≥15 mm. Age at diagnosis, gender, and number of months to maximum esophageal diameter were not associated with achieving either diameter.

Conclusions

Most patients with EoE with severe stricture experienced improvement in esophageal diameter to ≥15 mm with treatment, suggesting that the currently available treatment options are effective for patients with severe strictures. The most significant factors associated with disease reversibility are initial esophageal diameter and histologic remission.

中文翻译：

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成人严重嗜酸性食管炎的临床结局。

背景和目标

嗜酸性食道炎（EoE）是食道的炎症性疾病。在过去的30年中，其流行率一直在稳定增长。出现严重食管狭窄的EoE患者的预后知之甚少。这项研究的目的是描述患有严重狭窄的EoE患者的临床结果，并确定与食管直径改善可能性更大相关的因素。

方法

这项研究是对具有严重狭窄的EoE患者的回顾性图表回顾，EoE患者定义为在病程中某一时刻的食道直径为10 mm或更小。在按护理标准进行药物或饮食治疗以及反复的食管扩张手术的过程中，对每个患者的临床过程进行了跟踪。进行多变量回归分析，以确定哪些变量与内窥镜反应相关，这是通过将食管直径提高至13 mm和15 mm来定义的。

结果

从一组1091名EoE成人中，在66名患者中发现严重狭窄（7％）。在66例患者中，有59例（89％）的食管直径≥13 mm，有43例（65％）的食管直径≥15mm。初始直径（优势比，1.58； 95％置信区间，1.06-2.35；P  = .025）和组织学缓解（优势比，34.97； 95％置信区间，6.45-189.49；P  <.0001）与达到目标显着相关直径≥15mm。诊断时的年龄，性别和达到最大食管直径的月份数与达到任一直径均无关。

结论

大多数患有严重狭窄的EoE患者在治疗后经历了食管直径的改善，≥15 mm，这表明当前可用的治疗方案对严重狭窄的患者有效。与疾病可逆性相关的最重要因素是初始食管直径和组织学缓解。