Close follow‐up is associated with fewer stricture formation and results in earlier detection of histological relapse in the long‐term management of eosinophilic esophagitis

Abstract

Background and aims:No recommendations exist regarding optimal follow-up schedule in patients with eosinophilic esophagitis (EoE) under maintenance treatment. Methods:We retrospectively evaluated a long-term surveillance concept at the Swiss EoE clinic, where clinical, endoscopic and histological disease activity is assessed annually regardless of EoE symptoms. Data on 159 adult patients under maintenance steroid treatment with available follow-up were analyzed. Patients were classified as having close (duration between visits <18 months) or non-close follow-up (≥18 months). Results:We analyzed a total of 309 follow-up visits of 159 patients (123 males, age at diagnosis 38.9 � 15.4 years). 157 (51%) visits were within a close follow-up schedule (median duration between visits of 1.0 years (interquartile range (IQR) 0.9-1.2)), while 152 visits (49%) were not (median duration between visits 2.9 years (IQR 2.0-4.1)). There was no difference regarding ongoing clinical, endoscopic, and histological disease activity, and adherence to prescribed steroid treatment between the two groups. However, stricture formation was significantly less frequently observed at visits within a close follow-up schedule (22.9 vs. 33.6%, p = 0.038).Absence of close follow-up was a significant risk factor for stricture development in a multivariate regression model. Patients who achieved histological remission and were followed within a close-follow-up schedule had significantly earlier detection of histological relapse compared to patients not within such close follow-up. Conclusion:Close follow-up is associated with fewer stricture formation and appears to result in earlier detection of histological relapse in patients with

Worsened Fibrostenotic Outcomes in Eosinophilic Esophagitis Patients Due to COVID-19-Related Endoscopy Cancellations

“…A recent study by Bon and colleagues analyzed long-term follow-up in the Swiss EoE cohort and found that absence of close follow-up, defined as a year or less, was associated with stricture develop after controlling for potential confounding factors. These data are also consistent with our findings [ 11 ].…”

“…Second, of the patients who ultimately returned, their follow-up was delayed by an average of 6 months (with the next endoscopy more than a year after the previously scheduled procedure), and when they returned they tended to require higher rates of dilation and lost some esophageal caliber; some had even developed de-novo fibrostenosis. This adds to the emerging literature about EoE disease progression even after diagnosis and may inform discussions about the most appropriate monitoring intervals [ 10 , 11 ].…”

“…While there is currently some controversy related to the most appropriate monitoring intervals for patients with EoE under control after treatment, there is substantial evidence that with increasing symptom duration prior to diagnosis, EoE will present as a fibrostenotic phenotype in the majority, but not all, patients [ 2 , 5 – 9 ]. In addition, even after diagnosis EoE can progress to fibrostenosis if patients do not have regular monitoring [ 10 , 11 ].…”

Eosinophile Ösophagitis

“…Bei Patienten, die sich der medizinischen Behandlung entziehen, kommt es zu einer erneuten Krankheitsprogression und steigender Strikturrate 9 . Umgekehrt führt eine engere Nachsorge (alle 12 – 18 Monate) zu einer frühzeitigeren Entdeckung eines histologischen Rezidivs und zu einer niedrigeren Strikturrate 19 .…”

A role for age-associated alterations in esophageal epithelium in eosinophilic esophagitis-associated fibrosis

“…Delay in EoE diagnosis is also associated with increase in stricture in a time-dependent manner ( 20 ). Moreover, while gaps in clinical care of EoE patients are associated with progression to fibrostenosis ( 21 ), close follow-up is associated with a decrease in stricture in EoE patients ( 22 ). Taken together, these findings support the paradigm that chronic EoE inflammation promotes progression to fibrostenosis ( 15 ).…”