Dysphagia and health-related quality of life in patients with eosinophilic esophagitis: a long-term follow-up

Abstract

Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disease, with dysphagia as the main symptom. The aim of this study was to survey symptoms and health-related quality of life in adult patients with EoE at least 1 year after diagnosis and a 2-month course of topical corticosteroids. Forty-seven consecutive patients [79 % males, mean age 49 years (range 18-90 years)] were evaluated using three different questionnaires at three different occasions: the Watson Dysphagia Scale (WDS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Oesophageal Module 18 (EORTC QLQ-OES18) and the Short Form-36 (SF-36). The median time from diagnosis to the long-term follow-up was 23 months (range 12-34 months). The WDS scores and the EORTC QLQ-OES18 Dysphagia and Eating scale scores were improved after 2 months of treatment (p = 0.00007, p = 0.01, p = 0.004, respectively), as were the long-term follow-up scores (p = 0.01, p = 0.03, p = 0.005, respectively), relative to the scores at diagnosis. In addition, the EORTC QLQ-OES18 Choking scores were improved after the steroid course (p = 0.003) but not after the long-term follow-up. No significant differences were detected with respect to the SF-36 scores. In summary, EoE seems to be associated with a substantial burden of symptoms that improve significantly after treatment. A partial remission persists more than 1 year after diagnosis and the discontinuation of medication. The WDS and the EORTC QLQ-OES18 appear to be sensitive instruments appropriate for surveillance in these patients.

Systematic review: health‐related quality of life in children and adults with eosinophilic oesophagitis—instruments for measurement and determinant factors

“…Eight studies in literature have assessed HRQoL levels in adults with EoE using the generic measures Medical Outcome Study Sort Form (SF)‐36 and its abbreviated version SF‐12 . Two additional studies used the Gastrointestinal Quality of Life Index and the Patient Assessment of Upper Gastrointestinal Disorders‐Quality of Life (PAGI‐QOL) questionnaires, that were developed to assess QoL in dyspepsia, GERD and gastroparesis, among other conditions.…”

“…Two additional studies used the Gastrointestinal Quality of Life Index and the Patient Assessment of Upper Gastrointestinal Disorders‐Quality of Life (PAGI‐QOL) questionnaires, that were developed to assess QoL in dyspepsia, GERD and gastroparesis, among other conditions. A questionnaire validated to measure QoL in patients with oesophageal cancer has been also applied to adults with EoE …”

“…The effect of therapy on patients’ QoL also shows conflicting results: Swedish adult patients treated with swallowed topic steroids (aerosolised mometasone furoate orally applied) showed absence of changes in SF‐36 scores despite improvement in symptoms of dysphagia and chocking during the period of treatment . In contrast, a mild but nonsignificant increase in mean physical component and mental component scores were observed after a four food elimination diet‐based therapy in a series of 13 American adult patients, despite symptomatic improvement.…”

“…Thus, only 16 full papers (which represent 0.8% of the overall publications dealing with EoE indexed in PubMed) have HRQoL as the main research topic. Second, most of this research has been developed by well recognised groups from the USA, involving adults and paediatric patients, who were also responsible for developing and releasing the new disease‐specific instruments to measure HRQoL in EoE, with further European groups being involved in recent years . However, a majority of studies in the topic are exclusively available as abstracts presented in congresses.…”

Determinant factors of quality of life in adult patients with eosinophilic esophagitis

“…It is tempting to speculate whether identification and long-term exclusion of individual food triggers could also lead to improvements in HRQoL, as suggested in a recent study that assessed EoE with a nonspecific instrument. 9 Our study analyzed all determinant factors for each of the scores constituting the five subscales that integrate the EoE-QoL-A questionnaire. Among them, food impaction was the most relevant, significantly influencing the five subscales.…”