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Clinical outcomes of adults with eosinophilic esophagitis with severe stricture
Gastrointestinal Endoscopy ( IF 7.229 ) Pub Date : 2020-01-16 , DOI: 10.1016/j.gie.2020.01.015
Jooho P. Kim; Gabriel Weingart; Brent Hiramoto; Dyanna L. Gregory; Nirmala Gonsalves; Ikuo Hirano

Background & Aims Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus that has been steadily increasing in prevalence over the past three decades. The prognosis of EoE patients presenting with severe esophageal strictures is poorly understood. The aim of this study is to describe the clinical outcomes of EoE patients with severe stricture 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 millimeters (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 dilations. 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%) to ≥15 mm. Initial diameter (OR, 1.58; 95% CI, 1.06-2.35; P=0.025) and histologic remission (OR, 34.97; 95% CI, 6.45-189.49; P<0.0001) were significantly associated with achieving a ≥15 mm diameter. Age at diagnosis, gender, and number of months to maximum esophageal diameter were not associated with achieving either diameter. Conclusions The majority of 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.
更新日期:2020-01-21

 

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