Delay in Diagnosis of Eosinophilic Esophagitis Increases Risk for Stricture Formation in a Time-Dependent Manner

Eosinophilic Esophagitis–More than Two Decades of Progress

“…A delay in diagnosis and treatment has been associated with fibrotic features and strictures. A 0-2 year delay in diagnosis of EoE had a prevalence of 17% strictures, while those diagnosed > 20 years after symptom onset had a 71% prevalence of strictures (P < .001) [81]. In a recent retrospective study of 379 patients, the likelihood of fibrostenotic disease, characterized if there were esophageal rings, narrowing, or strictures, increased markedly with age.…”

Diagnosis and treatment of eosinophilic esophagitis in clinical practice

“…In children, unspecific symptoms (e.g., heartburn, nausea, vomiting, abdominal pain, or failure to thrive) are presented in addition to dysphagia, while in adults, eating difficulties (e.g., repeated dysphagia or food impaction) are predominantly presented [54]. This difference appears to be associated with the time-dependent disease progression in which active eosinophilic inflammation is predominantly present in children and subsequent fibrostenotic changes of the esophageal wall are the main complications in adults [55,56]. Dysfunction of the esophageal proper muscle layer is also considered to participate in symptom generation [57,58].…”

“…When dysphagia is mild and infrequent, the patient may not consult a doctor, likely considering the symptoms as part of their constitutional property. Thus, it is likely that this condition is underdiagnosed or that the diagnosis is delayed [56]. We also need to take into account that patients with EoE often have behavioral alternations, such as avoiding the foods previously responsible for dysphagia or impaction.…”

“…4) [87,88]. Subepithelial fibrosis in the esophageal wall progresses with persisting long-term eosinophilic inflammation, resulting in an esophagus of narrow caliber or with an esophageal stricture [55,56]. In some cases, a traumatic tear occurs with the passage of the endoscope, namely crepe-paper esophagus, indicative of mucosal fragility (Fig.…”

“…Patients requiring dilation are primarily adults since esophageal remodeling (e.g., esophageal stricture or narrowing) develops progressively during long-term and persistent eosinophilic inflammation [55,56]. Three types of procedures have primarily been employed, (1) the simple bougie; (2) the wire-guided bougie; and (3) through-the-scope (TTS) balloon dilation [142].…”