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Eosinophilic Esophagitis Is Rarely Continually Symptomatic 10 Years After an Initial Treatment Course in Adults

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Abstract

Introduction

Despite its initial description over 25 years ago, there is little known about the course of eosinophilic esophagitis (EoE) after an initial course of medical or dietary treatment. We aim to assess the long-term symptomology and quality of life (QoL) metrics in patients 10 years after initial treatment for eosinophilic esophagitis.

Methods

Inclusion criteria: single center study of EoE patients diagnosed over 10 years ago with completion of an 18-question structured telephone interview. A cohort of patient’s prospectively underwent an esophageal barium exam, esophageal sponge cytology, and evaluation by a esophagologist at greater than 10 years’ time since original diagnosis.

Results

A total of 54 patients were included in the study. The average age at follow-up was 55.0, with the majority male (64.8%). At the original diagnosis, 62.9% and 37.0% were initially treated with topical steroids and a proton pump inhibitor (PPI), respectively,compared to 59.3% and 7.4% after 10 years, and 7.4% of patients reported a history of dilatations. Only 11.8% noted avoidance of trigger foods, with 62.7% noting an unlimited diet without caution. QoL decrease secondary to EoE was noted to be trivial to minimal in 56.9% of patients, mild in 19.6%, moderate in 15.7% and severe in 7.8%. In the prospective follow-up cohort, the results of telephone survey results matched the direct physician-obtained interview in 88% of cases.

Conclusion

Ten years after diagnosis, treated EoE is rarely continually symptomatic, requires mainly PPI-based therapies and is associated with a minimal decrease in QoL scores.

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Abbreviations

EoE:

Eosinophilic esophagitis

GERD:

Gastroesophageal reflux disease

hpf:

High powered field

PPI:

Proton pump inhibitor

PPI-REE:

Proton pump inhibitor responsive esophageal eosinophilia

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Acknowledgments

Study supported by an unrestricted grant from Mayo Clinic Rochester Gastroenterology.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA

    A. J. Podboy

  2. Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA

    C. Lavey, D. Geno, S. Khana, K. Ravi, D. Katzka & J. Alexander

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    K. Mara

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Contributions

Dr. Podboy is a Gastroenterology and Hepatology fellow at Stanford University Hospital in Stanford, California. He was instrumental in the design and conduct of the study, data collection, and writing of the manuscript. Crystal Lavey is a research assistant in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. She assisted in the collection of the data. Debra Geno is a research assistant in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. She assisted in the collection of the data. Kristin Mara is a statistician in the Department of Health Sciences Research and assisted in the statistical methods, analysis and critical appraisal of the manuscript. Dr. Kanna is a gastroenterologist in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. He was instrumental in the critical appraisal of the manuscript. Dr. Katzka is a gastroenterologist in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. He was instrumental in data interpretation, writing and critical appraisal of the manuscript. Dr. Ravi is a gastroenterologist in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. He was instrumental in the critical appraisal of the manuscript. Dr. Alexander is a gastroenterologist in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. He was instrumental in the design and conduct of the study, data collection, critical appraisal and writing of the manuscript.

Corresponding author

Correspondence to J. Alexander.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article does not contain any studies with animals performed by any of the authors.

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Podboy, A.J., Lavey, C., Mara, K. et al. Eosinophilic Esophagitis Is Rarely Continually Symptomatic 10 Years After an Initial Treatment Course in Adults. Dig Dis Sci 64, 3568–3578 (2019). https://doi.org/10.1007/s10620-019-05636-0

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