EoE ToT Module 2 References-Dellon et al Gastrointest Endosc 2014 A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease

Dellon et al Gastrointest Endosc 2014 A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease

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The study conducted by Evan S. Dellon, MD, MPH, and colleagues at the University of North Carolina School of Medicine, explores the phenotypes of eosinophilic esophagitis (EoE) to delineate its progression as a disease. EoE is identified as a chronic, immune-mediated condition that manifests through esophageal dysfunction and eosinophilic infiltration. The study is retrospective, encompassing EoE cases from 2001-2011, and relies on a clinicopathologic database. <br /><br />The team aimed to characterize predefined EoE phenotypes, ascertain predictors, and infer the disease's natural course. The primary phenotypes were classified endoscopically into fibrostenotic (strictures and rings), inflammatory (furrows and plaques), and mixed types. The sample consisted of 379 patients, predominantly younger, male, and white, with dysphagia (66%) as the most common symptom.<br /><br />Key findings revealed that younger patients were generally more likely to present with the inflammatory phenotype. However, with increasing age, the likelihood of fibrostenotic phenotype increased significantly. Statistically, every ten-year age increment more than doubled the odds of developing the fibrostenotic phenotype (OR: 2.1). The mean duration of symptoms before diagnosis also correlated with phenotype; inflammatory cases had shorter pre-diagnosis symptom lengths (5 years) compared to mixed or fibrostenotic (8 years). Dysphagia emerged as a substantial independent predictor, raising the likelihood of fibrostenotic phenotype (OR: 7.0). Atopic status or levels of esophageal eosinophilia, however, showed no significant variance across phenotypes.<br /><br />The findings suggest that EoE progresses from an inflammatory to a fibrostenotic condition over time without treatment, underscoring the importance of early intervention to prevent structural complications. These phenotypic distinctions might influence treatment strategies and objectives, emphasizing the need for proactive management of eosinophilic inflammation to avert esophageal fibrosis and stricture development.<br /><br />Limitations include the retrospective design and single-center scope, which could affect generalizability. The study urges further examination of phenotypes, particularly their impact on treatment efficacy and disease prognosis. This insight into EoE's progressive nature opens avenues for tailored therapeutic approaches and highlights the necessity for vigilant long-term patient monitoring.

Keywords

Eosinophilic Esophagitis

EoE phenotypes

disease progression

fibrostenotic

inflammatory

dysphagia

retrospective study

early intervention

esophageal fibrosis

treatment strategies