Abstract

Background

Eosinophilic esophagitis is an inflammatory condition in which eosinophil infiltration leads to esophageal remodeling and stricturing, with dilation therapy often needed. Achieving histologic remission reduces the need for repeat dilation, although little is known about the effects of long-term maintenance therapy.

Aims

To further assess the relationship between short-term histologic remission and maintenance therapy on need for repeat dilation in eosinophilic esophagitis.

Methods

A total of 77 patients with eosinophilic esophagitis (59.7% male; mean age 41.6 years) seen at a single medical center from June 2000 to August 2017 were included. Information on history of dilation and therapy [proton pump inhibitors (PPIs), steroids, elimination diet] was collected. Mean follow-up was 164 weeks. Fifty-one patients achieved histologic remission and 42 of these remained on maintenance therapy (23 PPIs, 14 topical steroids, and 5 dietary therapy). Standard phone interview was completed in cases with lack of follow-up. Only patients who underwent esophageal dilation to ≥ 17 mm were included.

Results

A significantly lower proportion of patients on maintenance therapy required repeat dilation (12/42) compared with patients not on maintenance therapy (8/9) (hazard ratio 0.12; p < 0.001). Of patients who received maintenance therapy, 9.1% required re-dilation. The difference in need for repeat dilation in patients who achieved histologic remission on therapy (14/26) versus those who did not (20/51) was not significant (hazard ratio 1.34; p = 0.45).

Conclusion

In a retrospective analysis of patients with eosinophilic esophagitis, we found that a significantly lower proportion who received maintenance therapy (PPIs, steroids, or dietary exclusions) required repeat dilation.

中文翻译：

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嗜酸性食管炎维持治疗对复发性扩张的影响

摘要

背景

嗜酸性粒细胞性食管炎是一种炎症性疾病，其中嗜酸性粒细胞浸润导致食管重塑和狭窄，通常需要进行扩张疗法。尽管对长期维持治疗的效果知之甚少，但实现组织学缓解可减少重复扩张的需要。

目的

为了进一步评估短期组织学缓解与维持治疗之间的关系，需要在嗜酸性粒细胞性食管炎中反复扩张。

方法

纳入2000年6月至2017年8月在单个医疗中心就诊的77例嗜酸性粒细胞性食管炎患者（男性59.7％;平均年龄41.6岁）。收集有关扩张和治疗史的信息[质子泵抑制剂（PPI），类固醇，消除饮食]。平均随访164周。51例患者实现了组织学缓解，其中42例仍接受维持治疗（23种PPI，14种局部类固醇和5种饮食疗法）。如果没有随访，则完成标准的电话采访。仅包括接受食管扩张≥17 mm的患者。

结果

与未接受维持治疗的患者（8/9）相比，接受维持治疗的患者中需要重复扩张的比例显着降低（12/42）（危险比0.12；p  <0.001）。在接受维持治疗的患者中，有9.1％需要再次扩张。在治疗后达到组织学缓解的患者（14/26）与未达到组织学缓解的患者（20/51），需要重复扩张的差异不显着（危险比1.34；p  = 0.45）。

结论

在对嗜酸性粒细胞性食管炎患者的回顾性分析中，我们发现接受维持治疗（PPI，类固醇或饮食排斥）的比例明显降低，需要重复扩张。