Corey J Ketchem1, Kisan P Thakkar1, Angela Xue1, Sumana Reddy1, Lior Abramson1, Sydney B Greenberg1, Sonia Abichandani1, Talya L Miller2, Nicole C Chang1, Swathi Eluri1, Craig C Reed1, Evan S Dellon3. 1. Center for Esophageal Diseases and Swallowing, CB#7080 Bioinformatics Building, 130 Mason Farm Rd. UNC-CH, Chapel Hill, NC 27599-7080, United States. 2. Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, NC, United States. 3. Center for Esophageal Diseases and Swallowing, CB#7080 Bioinformatics Building, 130 Mason Farm Rd. UNC-CH, Chapel Hill, NC 27599-7080, United States; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, United States. Electronic address: edellon@med.unc.edu.
Abstract
BACKGROUND: There are few data assessing treatment response in older eosinophilic esophagitis (EoE) patients and we evaluated treatment outcomes to topical corticosteroids (tCS) in this older population. METHODS: This retrospective cohort study of the UNC EoE Clinicopathologic database included subjects with a new diagnosis of EoE treated with tCS. Histologic responses, global symptom response, and endoscopic changes were recorded. Older EoE patients (≥65 years) were compared to younger EoE patients (<65). RESULTS: We identified 467 EoE patients treated with tCS, 12 (3%) of whom were ≥65 years. Compared to those <65 years, patients ≥65 had longer symptom duration and worse endoscopy scores, but most clinical features were similar. Post-treatment peak eosinophil counts trended higher in the <65 group (25.0 vs 5.5; p = 0.07). Histological response was greater in the ≥65 population at <15 eos/hpf (92% vs 57%; p = 0.02), ≤6 eos/hpf (83% vs 50%; p = 0.02), and <1 eos/hpf (58% vs 29%; p = 0.03). Older age was independently associated with increased odds of histologic response (adjusted OR 8.48, 95% CI: 1.08-66.4). CONCLUSIONS: EoE patients ≥65 years had a higher likelihood of responding to tCS therapy, suggesting they should be studied more closely and included in future trials.
BACKGROUND: There are few data assessing treatment response in older eosinophilic esophagitis (EoE) patients and we evaluated treatment outcomes to topical corticosteroids (tCS) in this older population. METHODS: This retrospective cohort study of the UNC EoE Clinicopathologic database included subjects with a new diagnosis of EoE treated with tCS. Histologic responses, global symptom response, and endoscopic changes were recorded. Older EoE patients (≥65 years) were compared to younger EoE patients (<65). RESULTS: We identified 467 EoE patients treated with tCS, 12 (3%) of whom were ≥65 years. Compared to those <65 years, patients ≥65 had longer symptom duration and worse endoscopy scores, but most clinical features were similar. Post-treatment peak eosinophil counts trended higher in the <65 group (25.0 vs 5.5; p = 0.07). Histological response was greater in the ≥65 population at <15 eos/hpf (92% vs 57%; p = 0.02), ≤6 eos/hpf (83% vs 50%; p = 0.02), and <1 eos/hpf (58% vs 29%; p = 0.03). Older age was independently associated with increased odds of histologic response (adjusted OR 8.48, 95% CI: 1.08-66.4). CONCLUSIONS: EoE patients ≥65 years had a higher likelihood of responding to tCS therapy, suggesting they should be studied more closely and included in future trials.
Authors: Ikuo Hirano; Nelson Moy; Michael G Heckman; Colleen S Thomas; Nirmala Gonsalves; Sami R Achem Journal: Gut Date: 2012-05-22 Impact factor: 23.059
Authors: W Asher Wolf; Maya R Jerath; Sarah L W Sperry; Nicholas J Shaheen; Evan S Dellon Journal: Clin Gastroenterol Hepatol Date: 2014-01-17 Impact factor: 11.382
Authors: Ikuo Hirano; Evan S Dellon; Jennifer D Hamilton; Margaret H Collins; Kathryn Peterson; Mirna Chehade; Alain M Schoepfer; Ekaterina Safroneeva; Marc E Rothenberg; Gary W Falk; Yehudith Assouline-Dayan; Qiong Zhao; Zhen Chen; Brian N Swanson; Gianluca Pirozzi; Leda Mannent; Neil M H Graham; Bolanle Akinlade; Neil Stahl; George D Yancopoulos; Allen Radin Journal: Gastroenterology Date: 2019-10-05 Impact factor: 22.682
Authors: Evan S Dellon; John T Woosley; Ashley Arrington; Sarah J McGee; Jacquelyn Covington; Susan E Moist; Jessica H Gebhart; Alexandra E Tylicki; Shiyan O Shoyoye; Christopher F Martin; Joseph A Galanko; John A Baron; Nicholas J Shaheen Journal: Gastroenterology Date: 2019-03-11 Impact factor: 22.682
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: Evan S Dellon; Cary C Cotton; Jessica H Gebhart; Leana L Higgins; RoseMary Beitia; John T Woosley; Nicholas J Shaheen Journal: Clin Gastroenterol Hepatol Date: 2015-09-25 Impact factor: 11.382
Authors: Stephan Miehlke; Petr Hruz; Michael Vieth; Christian Bussmann; Ulrike von Arnim; Monther Bajbouj; Christoph Schlag; Ahmed Madisch; Christiane Fibbe; Henning Wittenburg; Hans Dieter Allescher; Max Reinshagen; Stefan Schubert; Jan Tack; Michaela Müller; Patrick Krummenerl; Joris Arts; Ralph Mueller; Karin Dilger; Roland Greinwald; Alex Straumann Journal: Gut Date: 2015-03-19 Impact factor: 23.059