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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(04): E545-E553
DOI: 10.1055/a-2280-8277
Original article

Long-term course of untreated asymptomatic esophageal eosinophilia and minimally symptomatic eosinophilic esophagitis

Yasuhiko Abe 
1   Division of Endoscopy, Yamagata University Hospital, Yamagata, Japan (Ringgold ID: RIN538443)
,
Ryosuke Kikuchi
2   Department of Gastroenterology, JR Sendai Hospital, Sendai, Japan (Ringgold ID: RIN38457)
,
Yu Sasaki
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Naoko Mizumoto
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Makoto Yagi
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Yusuke Onozato
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Takahiro Watabe
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Hiroki Goto
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Takahiro Miura
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Ryou Sato
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Minami Ito
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Hiroko Tsuchiya
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
,
Yoshiyuki Ueno
3   Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan (Ringgold ID: RIN38052)
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Abstract

Background and study aims The long-term course of untreated asymptomatic esophageal eosinophilia (aEE) and minimally symptomatic eosinophilic esophagitis (mEoE) are not well understood. This study aimed to clarify this course.

Patients and methods A total of 36 patients with EE who were endoscopically followed up for more than 5 years, and who underwent more than one endoscopy evaluation after the first diagnosis, were investigated. These patients were divided into two groups according to the presence or absence of the continuous treatment: no treatment group (NT group, n=22) and proton pump inhibitor/potassium competitive acid blocker group (Tx group, n=14). Symptoms and endoscopic and histological findings were retrospectively reviewed according to endoscopic phenotypes. Endoscopic assessment was performed using the EoE endoscopic reference score (EREFS).

Results The median follow-up period was 84.5 months in the Tx group and 92 months in the NT group. During the follow-up period, about half of the patients in the Tx-diffuse group persisted EREFS >3, while the remaining half had EREFS ≤2. The total EREFS in the NT-diffuse group remained almost unchanged (median: 2–4) without apparent exacerbation. In contrast, EREFS in the NT-localized group exhibited an unchanged or gradually decreasing trend, with statistical significance from the first diagnosis to 72 to 83 months after.

Conclusions Untreated aEE and mEoE are not likely to worsen even without treatment at least for a median follow-up of 7 years. Instead, the localized type may spontaneously improve, implying a different pathogenesis in the presence of the diffuse type. Further studies should clarify the long-term prognosis.

Keywords

Endoscopy Upper GI Tract - Eosinophilic esophagitis - GI Pathology - Epidemiology

Supplementary Material



Publication History

Received: 30 October 2023

Accepted after revision: 04 January 2024

Accepted Manuscript online:
04 March 2024

Article published online:
15 April 2024

© 2024. 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/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2024; 56(06): 468-468
DOI: 10.1055/a-2266-2839

 

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