Esophagus to Small Intestine

Clin Gastroenterol Hepatol. 2022;20(4):766–75.e4

Safroneeva E, Pan Z, King E, Martin LJ, Collins MH, Yang GY, Capocelli KE, Arva NC, Abonia JP, Atkins D, Bonis PA, Dellon ES, Falk GW, Gonsalves N, Gupta SK, Hirano I, Leung J, Menard-Katcher PA, Mukkada VA, Schoepfer AM, Spergel JM, Wershil BK, Rothenberg ME, Aceves SS, Furuta GT; Consortium of Eosinophilic Gastrointestinal Disease Researchers

Long-lasting dissociation of esophageal eosinophilia and symptoms after dilation in adults with eosinophilic esophagitis

Background and aims: Esophageal dilation improves dysphagia but not inflammation in eosinophilic esophagitis (EoE) patients. The authors investigated if dilation modifies the association between symptoms and peak esophageal eosinophils per high-power field (eos/hpf).
Methods: Adults enrolled in a multisite prospective Consortium of Gastrointestinal Eosinophilic Disease Researchers Outcome Measures for Eosinophilic Gastrointestinal Diseases Across Ages observational study completed the symptom-based Eosinophilic Esophagitis Activity Index (EEsAI) Patient-Reported Outcome instrument and underwent endoscopy with biopsy specimens. Patients were stratified based on dilation status as absent, performed ≤ 1 year before endoscopy, and performed > 1 year before endoscopy. Assessments included Spearman correlations of the relationship between symptoms and eos/hpf and linear regression with EEsAI as the outcome, eos/hpf as predictor, and interaction for dilation and eos/hpf.
Results: Among 100 patients (n = 61 males; median age, 37 years), 15 and 40 patients underwent dilation ≤ 1 year and > 1 year before index endoscopy, respectively. In non-dilated patients, the association between eos/hpf and symptoms was moderate (ρ = 0.49; p < 0.001); for a 10-eos/hpf increase, the predicted EEsAI increased by 2.69 (p = 0.002). In patients dilated ≤ 1 year and > 1 year before index endoscopy, this association was abolished (ρ = -0.38; p = 0.157 for ≤ 1 year and ρ = 0.02; p = 0.883 for > 1 year); for a 10-eos/hpf increase, the predicted EEsAI changed by -1.64 (p = 0.183) and 0.78 (p = 0.494), respectively. Dilation modified the association between symptoms and eos/hpf (p = 0.005 and p = 0.187 for interaction terms of eos/hpf and dilation ≤ 1 year before and > 1 year before index endoscopy, respectively).

Conclusions: In non-dilated eosinophilic esophagitis (EoE) adults, esophageal eosinophils per high-power field correlate modestly with symptoms; this correlation was no longer appreciated in dilated patients, and the dilation effects lasted longer than 1 year. Dilation status should be considered in studies evaluating EoE treatment and for clinical follow-up evaluation.

PD Dr. E. Safroneeva, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,

DOI: DOI: 10.1016/j.cgh.2021.05.049

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