CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(08): E1234-E1242
DOI: 10.1055/a-1492-2650
Original article

Extent of eosinophilic esophagitis predicts response to treatment

Hassan Ghoz
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Fernando F. Stancampiano
2  Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
,
Jose R. Valery
2  Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
,
Katie Nordelo
3  Clinical Research Internship Study Program (CRISP), Mayo Clinic, Jacksonville, Florida, United States
,
Balkishan Malviya
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Brian E. Lacy
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Dawn Francis
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Kenneth DeVault
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Ernest Bouras
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
,
Murli Krishna
4  Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, United States
,
William C. Palmer
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
› Author Affiliations

Abstract

Background and study aim The clinical impact of eosinophilic esophagitis (EoE) limited to the distal esophagus (Lim-EE) vs. diffuse involvement (Dif-EE) is unknown. This study compared clinical characteristics and outcomes of Lim-EE vs. Dif-EE.

Patients and methods This retrospective, single-center study of patients with EoE between December 2011 and December 2019 evaluated treatment response based on repeated pathology and/or clinical improvement using comparative statistics.

Results 479 patients were identified (126 Lim-EE, 353 Dif-EE). Lim-EE patients had a higher incidence of endoscopically identified esophagitis (23.0 % vs. 14.7 %; P = 0.04), were older (50.8 [SD 16.2] vs. 46.4 [SD 15.3] years; P = 0.007), and were more likely to present with iron deficiency anemia (5.6 % vs. 1.7 %; P = 0.05), dyspepsia (15.1 % vs. 8.8 %; P = 0.06) or for Barrett’s surveillance (10.3 % vs. 3.7 %; P = 0.02). Patients with Dif-EE presented more frequently with dysphagia (57.2 % vs. 45.2 %; P = 0.02). Both groups had similar proton pump inhibitor (87.2 % vs. 83.3 %; P = 0.37) and steroid (12.8 % vs. 21.4 %; P = 0.14) use. Patients with Lim-EE had a better clinicopathologic response (61.5 % vs. 44.8 %; P = 0.009). On multivariate analysis, EoE extent predicted treatment response with an odds ratio of 1.89 (95 % confidence interval 1.13–3.20; P = 0.02). However, treatment response based only on repeat biopsy results showed no statistical difference between Lim-EE (52.5 %) and Dif-EE (39.7 %; P = 0.15).

Conclusions Lim-EE may represent a distinct phenotype separate from Dif-EE, with more overlap with gastroesophageal reflux disease and better treatment response.

Supplementary material



Publication History

Received: 18 November 2020

Accepted: 15 March 2021

Publication Date:
16 July 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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