EoE Module 10 References-Runge et al Dis Esophagus 2017 Control of inflammation decreases the need for subsequent esophageal dialation in patients with EoE

Runge et al Dis Esophagus 2017 Control of inflammation decreases the need for subsequent esophageal dialation in patients with EoE

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The study aimed to assess if controlling esophageal inflammation with topical steroid treatments in patients with eosinophilic esophagitis (EoE) affects the need for subsequent esophageal dilation. Conducted retrospectively, the study included 55 EoE patients who initially underwent esophageal dilation, later received topical steroid treatment, and had subsequent biopsies. Patients were categorized as responders (27 individuals) or nonresponders (28 individuals) based on histologic response to treatment, defined by a reduction of eosinophil presence to less than 15 eosinophils per high-power field.<br /><br />Over approximately 19 months of follow-up, responders required significantly fewer dilations (averaging 1.6) compared to nonresponders (averaging 4.6, P=0.03), while achieving comparable esophageal diameter increases from dilation. Responders also had a longer interval before needing the first subsequent dilation, indicated by lower rates of dilation per month. Despite the study's retrospective design and limitations like potential differences in treatment outside the studied institution, the findings suggest that effective control of inflammation in EoE with topical steroids significantly decreases the necessity for esophageal dilation procedures.<br /><br />Clinically, this supports inflammation control in managing EoE to potentially slow progression to fibrosis, reduce endoscopic procedures, associated risks, and healthcare costs. These outcomes highlight the importance of achieving a histological endpoint of fewer than 15 eosinophils per high-power field. While the study focused on adult patients at a single institution, and results may not fully apply to pediatric cases, it provides a robust rationale for anti-inflammatory treatment in EoE patients exhibiting fibrostenotic characteristics necessitating baseline dilation. Further research could explore if similar effects are observed with dietary elimination therapies for inflammation control.

Keywords

eosinophilic esophagitis

esophageal inflammation

topical steroids

esophageal dilation

histologic response

eosinophil reduction

inflammation control

fibrostenotic characteristics

retrospective study

healthcare costs