Swathi Eluri1, Thomas M Runge1, Cary C Cotton1, Caitlin M Burk1, W Asher Wolf1, John T Woosley2, Nicholas J Shaheen3, Evan S Dellon3. 1. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. 2. Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. 3. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Abstract
BACKGROUND AND AIMS: Some patients with eosinophilic esophagitis (EoE) have an extremely narrow esophagus, but the characteristics of this group have not been extensively described. We aimed to characterize the narrow-caliber phenotype of EoE, determine associated risk factors, and identify differences in treatment response in this subgroup of patients. METHODS: This retrospective cohort study from 2001 to 2014 included subjects with a new diagnosis of EoE per consensus guidelines. Demographic, endoscopic, histologic, and treatment response data were extracted from medical records. An extremely narrow-caliber esophagus was defined when a neonatal endoscope was required to traverse the esophagus due to the inability to pass an adult endoscope. Patients with and without an extremely narrow-caliber esophagus were compared. Multivariable logistical regression was performed to assess treatment outcomes. RESULTS: Of 513 patients with EoE, 46 (9%) had an extremely narrow-caliber esophagus. These patients were older (33 vs 22 years; P < .01), had longer symptom duration (11 vs 3 years; P < .01), more dysphagia (98% vs 66%; P < .01), and food impactions (53% vs 31%; P < .01). Dilation was more common with extreme narrowing (69% vs 17%; P < .01). Patients with a narrow-caliber esophagus were more refractory to steroid treatment, with lower symptom (56% vs 85%), endoscopic (52% vs 76%), and histologic (33% vs 63%) responses (P < .01 for all), and these differences persisted after multivariate analysis. CONCLUSION: The extremely narrow-caliber esophagus is a more treatment-resistant subphenotype of EoE and is characterized by longer symptom duration and the need for multiple dilations. Recognition of an extremely narrow-caliber esophagus at diagnosis of EoE can provide important prognostic information.
BACKGROUND AND AIMS: Some patients with eosinophilic esophagitis (EoE) have an extremely narrow esophagus, but the characteristics of this group have not been extensively described. We aimed to characterize the narrow-caliber phenotype of EoE, determine associated risk factors, and identify differences in treatment response in this subgroup of patients. METHODS: This retrospective cohort study from 2001 to 2014 included subjects with a new diagnosis of EoE per consensus guidelines. Demographic, endoscopic, histologic, and treatment response data were extracted from medical records. An extremely narrow-caliber esophagus was defined when a neonatal endoscope was required to traverse the esophagus due to the inability to pass an adult endoscope. Patients with and without an extremely narrow-caliber esophagus were compared. Multivariable logistical regression was performed to assess treatment outcomes. RESULTS: Of 513 patients with EoE, 46 (9%) had an extremely narrow-caliber esophagus. These patients were older (33 vs 22 years; P < .01), had longer symptom duration (11 vs 3 years; P < .01), more dysphagia (98% vs 66%; P < .01), and food impactions (53% vs 31%; P < .01). Dilation was more common with extreme narrowing (69% vs 17%; P < .01). Patients with a narrow-caliber esophagus were more refractory to steroid treatment, with lower symptom (56% vs 85%), endoscopic (52% vs 76%), and histologic (33% vs 63%) responses (P < .01 for all), and these differences persisted after multivariate analysis. CONCLUSION: The extremely narrow-caliber esophagus is a more treatment-resistant subphenotype of EoE and is characterized by longer symptom duration and the need for multiple dilations. Recognition of an extremely narrow-caliber esophagus at diagnosis of EoE can provide important prognostic information.
Authors: Evan S Dellon; Xiaoxin Chen; C Ryan Miller; John T Woosley; Nicholas J Shaheen Journal: Am J Gastroenterol Date: 2012-07-10 Impact factor: 10.864
Authors: Chris A Liacouras; Glenn T Furuta; Ikuo Hirano; Dan Atkins; Stephen E Attwood; Peter A Bonis; A Wesley Burks; Mirna Chehade; Margaret H Collins; Evan S Dellon; Ranjan Dohil; Gary W Falk; Nirmala Gonsalves; Sandeep K Gupta; David A Katzka; Alfredo J Lucendo; Jonathan E Markowitz; Richard J Noel; Robert D Odze; Philip E Putnam; Joel E Richter; Yvonne Romero; Eduardo Ruchelli; Hugh A Sampson; Alain Schoepfer; Nicholas J Shaheen; Scott H Sicherer; Stuart Spechler; Jonathan M Spergel; Alex Straumann; Barry K Wershil; Marc E Rothenberg; Seema S Aceves Journal: J Allergy Clin Immunol Date: 2011-04-07 Impact factor: 10.793
Authors: Glenn T Furuta; Chris A Liacouras; Margaret H Collins; Sandeep K Gupta; Chris Justinich; Phil E Putnam; Peter Bonis; Eric Hassall; Alex Straumann; Marc E Rothenberg Journal: Gastroenterology Date: 2007-08-08 Impact factor: 22.682
Authors: Evan S Dellon; Ademola Aderoju; John T Woosley; Robert S Sandler; Nicholas J Shaheen Journal: Am J Gastroenterol Date: 2007-07-07 Impact factor: 10.864
Authors: N Gentile; D Katzka; K Ravi; S Trenkner; F Enders; J Killian; L Kryzer; N J Talley; J Alexander Journal: Aliment Pharmacol Ther Date: 2014-10-07 Impact factor: 8.171
Authors: Tetsuo Shoda; Ting Wen; Seema S Aceves; J Pablo Abonia; Dan Atkins; Peter A Bonis; Julie M Caldwell; Kelley E Capocelli; Christina L Carpenter; Margaret H Collins; Evan S Dellon; Michael D Eby; Nirmala Gonsalves; Sandeep K Gupta; Gary W Falk; Ikuo Hirano; Paul Menard-Katcher; Jonathan T Kuhl; Jeffrey P Krischer; John Leung; Vincent A Mukkada; Jonathan M Spergel; Michael P Trimarchi; Guang-Yu Yang; Nives Zimmermann; Glenn T Furuta; Marc E Rothenberg Journal: Lancet Gastroenterol Hepatol Date: 2018-05-03
Authors: Swathi Eluri; Sara R Selitsky; Irina Perjar; Johnathan Hollyfield; Renee Betancourt; Cara Randall; Spencer Rusin; John T Woosley; Nicholas J Shaheen; Evan S Dellon Journal: Clin Gastroenterol Hepatol Date: 2018-09-10 Impact factor: 11.382
Authors: Kelly M O'Shea; Seema S Aceves; Evan S Dellon; Sandeep K Gupta; Jonathan M Spergel; Glenn T Furuta; Marc E Rothenberg Journal: Gastroenterology Date: 2017-07-27 Impact factor: 22.682