Eosinophilic oesophagitis: relationship of quality of life with clinical, endoscopic and histological activity

Abstract

Summary Background Knowledge about determinants of quality of life (QoL) in eosinophilic oesophagitis (EoO) patients helps to identify patients at risk of experiencing poor QoL and to tailor therapeutic interventions accordingly. Aim To evaluate the impact of symptom severity, endoscopic and histological activity on EoE‐specific QoL in adult EoE patients. Methods Ninety‐eight adult EoE patients were prospectively included (64% male, median age 39 years). Patients completed two validated instruments to assess EoE‐specific QoL (EoO‐QoL‐A) and symptom severity (adult EoE activity index patient‐reported outcome) and then underwent esophagogastroduodenoscopy with biopsy sampling. Physicians reported standardised information on EoE‐associated endoscopic and histological alterations. The Spearman's rank correlation coefficient was calculated to determine the relationship between QoL and symptom severity. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms, endoscopic and histological findings explain variations in QoL. Results Quality of life strongly correlated with symptom severity (r = 0.610, P < 0.001). While the variation in severity of symptoms, endoscopic and histological findings alone explained 38%, 35% and 22% of the variability in EoE‐related QoL, respectively, these together explained 60% of variation. Symptom severity explained 18–35% of the variation in each of the five QoL subscale scores. Conclusions Eosinophilic oesophagitis symptom severity and biological disease activity determine QoL in adult patients with eosinophilic oesophagitis. Therefore, reduction in both eosinophilic oesophagitis symptoms as well as biological disease activity is essential for improvement of QoL in adult patients. http://Clinicaltrials.gov number, NCT00939263.

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

“…Although recurrent food impaction significantly affected most of the EoE-QoL-A dimensions, female gender exclusively affected the eating/diet impact dimension. Our research reinforces symptoms as a strong determinant for disease-specific HRQoL, as previously shown in a recent research, 11 that assessed overall EoE symptoms by measured with the Eosinophilic Esophagitis Activity Index (EEsAI) symptoms score. The EEsAI score is a seven-item instrument that derives five components of the overall score (frequency of trouble swallowing, duration of trouble swallowing, swallowing-associated pain, the visual dysphagia question score and the avoidance, modification and slow eating score), providing a total score ranging from 0 (inactive EoE) to 100 points (very active EoE).…”

Novel immunologic mechanisms in eosinophilic esophagitis

“…The disease clinically features esophageal dysfunction and frequently associates with atopic conditions [1]. The incidence and prevalence of EoE are increasing [2], and the disease negatively impacts patients’ quality of life [3]. Although EoE is well established to be a type 2 cytokine-associated disease, novel innate and adaptive immunological mechanisms underlying the disease continue to be uncovered.…”

A visual analogue scale and a Likert scale are simple and responsive tools for assessing dysphagia in eosinophilic oesophagitis

“…30 Only recently have two instruments have been validated to measure dysphagia in EoE, 14,31 and their use is largely limited to research applications at this time. For routine clinical use, a simpler measure may be preferable.…”