Luc Biedermann1, Mark Holbreich2, Dan Atkins3, Mirna Chehade4, Evan S Dellon5, Glenn T Furuta6, Ikuo Hirano7, Nirmala Gonsalves7, Thomas Greuter1, Sandeep Gupta8, David A Katzka9, Willemijn De Rooij10, Ekaterina Safroneeva11, Alain Schoepfer12, Philipp Schreiner1, Dagmar Simon13, Hans Uwe Simon14,15, Marijn Warners10, Albert-Jan Bredenoord10, Alex Straumann1. 1. Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. 2. Allergy and Asthma Consultant, Indianapolis, IN, USA. 3. Children's Hospital Colorado Anschutz Medical Campus Aurora, Aurora, CO, USA. 4. Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5. Divison of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 6. Digestive Health Institute, Children's Hospital Colorado, Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, CO, USA. 7. Feinberg School of Medicine, Nothwestern University, Chicago, IL, USA. 8. Department of Pediatrics, University of Illinois, Peoria, IL, USA. 9. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. 10. Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. 11. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 12. Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. 13. Department of Dermatology, University Hospital Inselspital Bern, Bern, Switzerland. 14. Institute of Pharmacology, University of Bern, Bern, Switzerland. 15. Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia.
Abstract
BACKGROUND: Dysphagia is the main symptom of adult eosinophilic esophagitis (EoE). We describe a novel syndrome, referred to as "food-induced immediate response of the esophagus" (FIRE), observed in EoE patients. METHODS: Food-induced immediate response of the esophagus is an unpleasant/painful sensation, unrelated to dysphagia, occurring immediately after esophageal contact with specific foods. Eosinophilic esophagitis experts were surveyed to estimate the prevalence of FIRE, characterize symptoms, and identify food triggers. We also surveyed a large group of EoE patients enrolled in the Swiss EoE Cohort Study for FIRE. RESULTS: Response rates were 82% (47/57) for the expert and 65% (239/368) for the patient survey, respectively. Almost, 90% of EoE experts had observed the FIRE symptom complex in their patients. Forty percent of EoE patients reported experiencing FIRE, more commonly in patients who developed EoE symptoms at a younger age (mean age of 46.4 years vs 54.1 years without FIRE; P < .01) and in those with high allergic comorbidity. Food-induced immediate response of the esophagus symptoms included narrowing, burning, choking, and pressure in the esophagus appearing within 5 minutes of ingesting a provoking food that lasted less than 2 hours. Symptom severity rated a median 7 points on a visual analogue scale from 1 to 10. Fresh fruits/vegetables and wine were the most frequent triggers. Endoscopic food removal was significantly more commonly reported in male patients with vs without FIRE (44.3% vs 27.6%; P = .03). CONCLUSIONS: Food-induced immediate response of the esophagus is a novel syndrome frequently reported in EoE patients, characterized by an intense, unpleasant/painful sensation occurring rapidly and reproducibly in 40% of surveyed EoE patients after esophageal contact with specific foods.
BACKGROUND:Dysphagia is the main symptom of adult eosinophilic esophagitis (EoE). We describe a novel syndrome, referred to as "food-induced immediate response of the esophagus" (FIRE), observed in EoE patients. METHODS: Food-induced immediate response of the esophagus is an unpleasant/painful sensation, unrelated to dysphagia, occurring immediately after esophageal contact with specific foods. Eosinophilic esophagitis experts were surveyed to estimate the prevalence of FIRE, characterize symptoms, and identify food triggers. We also surveyed a large group of EoE patients enrolled in the Swiss EoE Cohort Study for FIRE. RESULTS: Response rates were 82% (47/57) for the expert and 65% (239/368) for the patient survey, respectively. Almost, 90% of EoE experts had observed the FIRE symptom complex in their patients. Forty percent of EoE patients reported experiencing FIRE, more commonly in patients who developed EoE symptoms at a younger age (mean age of 46.4 years vs 54.1 years without FIRE; P < .01) and in those with high allergic comorbidity. Food-induced immediate response of the esophagus symptoms included narrowing, burning, choking, and pressure in the esophagus appearing within 5 minutes of ingesting a provoking food that lasted less than 2 hours. Symptom severity rated a median 7 points on a visual analogue scale from 1 to 10. Fresh fruits/vegetables and wine were the most frequent triggers. Endoscopic food removal was significantly more commonly reported in male patients with vs without FIRE (44.3% vs 27.6%; P = .03). CONCLUSIONS: Food-induced immediate response of the esophagus is a novel syndrome frequently reported in EoE patients, characterized by an intense, unpleasant/painful sensation occurring rapidly and reproducibly in 40% of surveyed EoE patients after esophageal contact with specific foods.
Authors: Philipp Schreiner; Luc Biedermann; Thomas Greuter; Benjamin L Wright; Alex Straumann Journal: Dis Esophagus Date: 2021-01-11 Impact factor: 3.429
Authors: Martina Votto; Matteo Naso; Andrea Martina Clemente; Maria De Filippo; Ginevra Gargiulo; Veronica Granone; Giulia Siri; Gian Luigi Marseglia; Amelia Licari Journal: Acta Biomed Date: 2022-06-06