EoE ToT Module 2 References-Schoepfer et al Gastroenterology 2013 Delay in diagnosis of EoE increases risk for stricture formation in a time dependent manner

Schoepfer et al Gastroenterology 2013 Delay in diagnosis of EoE increases risk for stricture formation in a time dependent manner

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The study investigates the impact of delayed diagnosis of eosinophilic esophagitis (EoE) on the development of esophageal strictures, using data from the Swiss EoE Database. EoE is an immune/antigen-mediated, chronic esophageal disease characterized by symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. EoE patients may present with inflammatory, stricturing, or mixed phenotypes. The retrospective study included 200 symptomatic EoE patients and examined the correlation between diagnostic delay and the development of strictures.<br /><br />Key findings indicate that longer diagnostic delays result in a higher prevalence of fibrotic features. The median delay was 6 years, and with extended delays, strictures increased from 17.2% (0-2 years delay) to 70.8% (20 years delay). The study concluded that untreated EoE leads to a shift from inflammatory to fibrotic phenotypes, which underscores the necessity for timely diagnosis to prevent strictures.<br /><br />Stricture severity was assessed based on endoscopic difficulty, and 75 patients (37.5%) had strictures at diagnosis. The study also identified that the primary risk factor for stricture formation is the length of the diagnostic delay. Younger patients (especially those diagnosed before age 20) tend to experience longer delays, potentially due to the hesitancy to perform invasive procedures on children and differing clinical perceptions of dysphagia across age groups.<br /><br />Overall, the study highlights the chronic nature of EoE and the necessity for early diagnosis to mitigate complications such as strictures. The findings advocate for healthcare strategies to expedite the diagnosis of EoE, particularly in younger populations, to prevent progression to severe disease states.

Keywords

eosinophilic esophagitis

EoE

esophageal strictures

diagnostic delay

Swiss EoE Database

fibrotic features

inflammatory phenotypes

stricture severity

early diagnosis

younger patients