Systematic review with meta‐analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis

Moawad, Fouad J.; Molina–Infante, Javier; Lucendo, Alfredo J.; Cantrell, Sarah; Tmanova, Lyubov L.; Douglas, Kevin

doi:10.1111/apt.14123

Cited by 98 publications

(72 citation statements)

References 60 publications

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“…The effective therapies available to adults with EoE are numerous . We hypothesise that similar to other chronic conditions, knowledge of EoE patients’ expectations towards therapy in conjunction with, among others, adequate health literacy, and good physician‐patient partnership may lead to better decisions about the choice of therapy and reduce nonadherence .…”

Section: Discussionmentioning

confidence: 99%

Adults with eosinophilic oesophagitis identify symptoms and quality of life as the most important outcomes

Safroneeva

Balsiger

Hafner

et al. 2018

Aliment Pharmacol Ther

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Summary Background Well informed patients who are in cohesive partnership with physicians and who have realistic expectations towards therapy are more likely to be adherent, which results in better disease control. Aim To assess which therapy goals adults with eosinophilic oesophagitis consider relevant. Methods Following refinement during three focus groups, a study brochure and questionnaire were sent to 148 patients. Patients ranked the importance (five levels) of short‐term (in the next 3 months) and long‐term (≥1 year) treatment effect on symptoms, quality of life (QoL), histologically‐detected inflammation and fibrosis, endoscopically‐detected inflammation, and stricture formation as well as achieving histological remission while asymptomatic. Patients’ characteristics associated with treatment goals were identified using logistic regression. Results Of 109 respondents (mean age 43 years), 85 were men. Over 90% chose symptoms and QoL improvement as important short‐ and long‐term therapy goals. A greater proportion attributed more importance to long‐term reduction in endoscopic (90% vs 73%, P < 0.001) and histological (81% vs 62%, P = 0.002) inflammation, and histologically‐detected fibrosis (79% vs 64%, P = 0.018) when compared to short‐term reduction in these features. Patients (88%) ranked achieving histological remission while being asymptomatic as important. Gender, therapy use, education level, QoL, symptom severity, and history of dilation were associated with patients’ choice of treatment goals. Conclusions Patients attributed most importance to improvement in symptoms and QoL. Reduction in biological activity was judged less important, but more relevant in the long‐ compared to the short‐term.

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Section: Discussionmentioning

confidence: 99%

Adults with eosinophilic oesophagitis identify symptoms and quality of life as the most important outcomes

Safroneeva

Balsiger

Hafner

et al. 2018

Aliment Pharmacol Ther

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“…Esophageal dilation is reserved for patients with treatment‐resistant disease, dysphagia, and/or food impactions. Although early case series reported high rates of perforations in adults with EoE, recent meta‐analysis indicates that esophageal dilation (both balloon and bougie) is safe for both pediatric and adult patients . The most frequent complications reported are mucosal tear and chest pain .…”

Section: Treatment Of Fibrosis In Eoementioning

confidence: 99%

“…The most frequent complications reported are mucosal tear and chest pain . Despite dilation and concurrent treatment with topical corticosteroids, a high percentage of patients require repeat dilations suggestive of possible ongoing remodeling …”

Section: Treatment Of Fibrosis In Eoementioning

confidence: 99%

“…6 Despite conventional therapies of corticosteroids or dietary elimination, a subset of patients are nonresponsive [7][8][9][10][11] and progress to stenosis requiring recurrent esophageal dilations ( Fig. 1), 10,[12][13][14][15] that can have a significant impact on quality of life. 16 As understanding of the pathophysiology of EoE begins to unfold, TGF-1 has been identified as the central mediator of fibrosis in EoE.…”

Section: Introductionmentioning

confidence: 99%

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Understanding fibrosis in eosinophilic esophagitis: Are we there yet?

Armbruster‐Lee

Cavender

Lieberman³

et al. 2018

Journal of Leukocyte Biology

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Eosinophilic esophagitis (EoE) is an immune/antigen-mediated, progressive fibrostenotic disease characterized by symptoms of esophageal dysfunction and abnormal eosinophilic infiltration in the esophagus. Despite current treatment modalities of dietary antigen elimination or topical corticosteroids, a subset of patients do not have clinical or histologic response. Even with resolution of superficial epithelial eosinophilia, patients may still have progressive subepithelial fibrosis, which may lead to esophageal strictures over time. Histologic identification of subepithelial fibrosis requires deep esophageal biopsies, which are not routinely obtained. Herein, we review the challenges in diagnosing and treating fibrosis in EoE. We propose the novel concept of vitamin D supplementation to treat fibrosis in EoE through downregulation of profibrotic mediator, transforming growth factor-beta.

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“…Other therapeutic options include elimination diets, such as the six-food elimination diet (SFED), and topical steroid medications. These three treatments are focused on mitigating ongoing inflammation; however, once fibrosis develops esophageal dilation often proves necessary to relieve the complaint of dysphagia [8][9][10]. One clinical difficulty is assessing the severity of fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Intrabolus Pressure Has Better Correlation Than Eosinophilia with Dysphagia Severity in Fibrostenotic Eosinophilic Esophagitis: A Pilot Study

Colizzo

Clayton

Kumar

et al. 2018

Gastrointestinal Disorders

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Eosinophilic esophagitis is characterized by dysphagia with esophageal eosinophilia. We sought to determine if intrabolus pressure measurements on high-resolution manometry had any correlation with dysphagia improvement following standard therapy for patients with fibrostenotic eosinophilic esophagitis. Consecutive patients were prospectively enrolled at our swallowing center. Dysphagia scores, esophageal eosinophil counts, endoscopic reference scores, and intrabolus pressure measurements were compared at baseline and following therapy with 8 weeks of a proton-pump inhibitor and serial bougie dilation to a luminal diameter of 17 mm. Five patients were included in the study. The median age was 38 years. The average endoscopic reference score improved from 5.0 to 2.4 (p = 0.007). The mean esophageal diameter improved from 10.8 mm to 17.2 mm (p = 0.001). Dysphagia severity scores improved from a mean value of 34.2 to 10.8 (p = 0.004). Mucosal eosinophilia had no correlation with dysphagia severity. Mean intrabolus pressure improved from 21.8 mmHg to 11 mmHg (p = 0.001). There was strong correlation between a decrease in intrabolus pressure and improvement in dysphagia severity; however, this was not significant (p = 0.108). Intrabolus pressure has strong correlation with dysphagia severity following therapy for fibrostenotic eosinophilic esophagitis. Bougie dilation provides improvement in dysphagia despite persistent mucosal eosinophilia.

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Systematic review with meta‐analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis

Abstract: Endoscopic dilation is consistently effective in children and adults with EoE, resulting in improvement in 95% of patients with very low rates (<1%) of major complications.

Cited by 98 publications

References 60 publications

Adults with eosinophilic oesophagitis identify symptoms and quality of life as the most important outcomes

Adults with eosinophilic oesophagitis identify symptoms and quality of life as the most important outcomes

Understanding fibrosis in eosinophilic esophagitis: Are we there yet?

Intrabolus Pressure Has Better Correlation Than Eosinophilia with Dysphagia Severity in Fibrostenotic Eosinophilic Esophagitis: A Pilot Study

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