Su1862 Systematic, Endoscopic Assessment Demonstrates Increased Fibrostenotic and Decreased Inflammatory Esophageal Features in Adults Compared With Children With Eosinophilic Esophagitis

Vashi, Ronak; Kagalwalla, Amir F.; Amsden, Katie; Mughal, Sabena; Weber, Gregory A.; Gonsalves, Nirmala; Hirano, Ikuo

doi:10.1016/s0016-5085(13)61827-2

Cited by 2 publications

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“…9–12 Similarly, endoscopic findings have been reported to vary by age as well, with a normal appearing esophagus, linear furrows, and white plaques more common in children, and esophageal rings, strictures, and narrowing more common in adults. 7, 9, 13 In natural history studies, while there are few children who have been observed for many years without treatment, 3, 14, 15, 34, 35 progression from inflammatory to fibrostenotic phenotypes has been noted anecdotally.…”

Section: Discussionmentioning

confidence: 99%

“…It is well recognized that clinical and endoscopic features of children and adults with EoE differ. 2, 5, 7, 9–13 Children tend to present with heartburn, vomiting, abdominal pain, feeding intolerance, or failure to thrive, while adults primarily present with dysphagia. While adults often have esophageal rings and strictures requiring dilation, children tend to have more furrows, plaques, and decreased vascularity on endoscopy.…”

Section: Introductionmentioning

confidence: 99%

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A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease

Dellon

Kim

Sperry

et al. 2014

Gastrointestinal Endoscopy

399

329

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Background Phenotypes of eosinophilic esophagitis (EoE) are not well characterized. Objective To describe clinical features of EoE patients with predefined phenotypes, determine predictors of these phenotypes, and make inferences about the natural history of EoE. Design Retrospective study. Setting Tertiary care center. Patients Incident EoE cases from 2001–2011 who met consensus diagnostic guidelines. Interventions n/a Main outcome measurements Endoscopic phenotypes, including fibrostenotic, inflammatory, or mixed. Other groups of clinical characteristics examined included atopy, level of esophageal eosinophilia, and age of symptom onset. Multinominal logistic regression assessed predictors of phenotype status. Results Of 379 cases of EoE identified, there were no significant phenotypic differences by atopic status or level of eosinophilia. Those with the inflammatory phenotype were more likely to be younger than those with mixed or fibrostenotic (13 vs 29 vs 39 years, respectively; p<0.001), and less likely to have dysphagia, food impaction, and esophageal dilation (p<0.001 for all). The mean symptom length prior to diagnosis was shorter for inflammatory (5 vs 8 vs 8 years; p=0.02). After multivariate analysis, age and dysphagia independently predicted phenotype. The OR for fibrostenosis for each 10-year increase in age was 2.1 (1.7–2.7). The OR for dysphagia was 7.0 (2.6–18.6). Limitations Retrospective, single-center study. Conclusions In this large EoE cohort, the likelihood of fibrostenosing disease increased markedly with age. For every ten year increase in age, the odds of having a fibrostenotic EoE phenotype more than doubled. This association suggests that the natural history of EoE is a progression from an inflammatory to a fibrostenotic disease.

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