EoE ToT Module 3 References-Dellon et al Gastrointest Endosc 2014 A phenotypic analysis shows EoE is a progressive fibrostenotic disease

Dellon et al Gastrointest Endosc 2014 A phenotypic analysis shows EoE is a progressive fibrostenotic disease

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A comprehensive retrospective study was conducted at the University of North Carolina to characterize phenotypes of eosinophilic esophagitis (EoE) and infer their natural history and predictors. The study evaluated 379 EoE cases diagnosed between 2001 and 2011 who met consensus diagnostic criteria. Three endoscopic phenotypes were predefined: fibrostenotic, inflammatory, and mixed. Key patient characteristics, such as atopic conditions, eosinophil levels, and age at symptom onset, were examined to determine how these factors influenced phenotype.<br /><br />Results highlighted significant phenotypic differences: inflammatory phenotype subjects were generally younger (average age 13), with shorter symptom duration prior to diagnosis (mean 5 years), and less likely to experience dysphagia or food impaction compared to others. In contrast, fibrostenotic patients were older (average age 39) and frequently had dysphagia and esophageal strictures, reflecting progressive disease. Mixed phenotypes showcased a combination of both inflammatory and fibrostenotic traits.<br /><br />Multivariate analysis showed age and dysphagia as independent predictors of phenotype, with the odds of having fibrostenotic EoE doubling with each ten-year increase in age. The lack of significant differences in clinical characteristics based on atopic status or eosinophil levels suggested that these factors might not be major phenotype predictors.<br /><br />The study supports a model where EoE naturally progresses from an inflammatory to a fibrostenotic state over time due to chronic eosinophilic inflammation leading to tissue remodeling and fibrosis. This could suggest a rationale for early and aggressive treatment to potentially prevent fibrostenotic complications.<br /><br />Limitations included the retrospective, single-center nature of the study and reliance on endoscopic findings, which might vary in interpretation. Future prospective cohort studies could provide more definitive data, especially regarding therapeutic interventions and long-term outcomes. Overall, this study's findings underscore the importance of recognizing different EoE phenotypes and their progression to tailor treatment approaches effectively.

Keywords

eosinophilic esophagitis

phenotypes

retrospective study

University of North Carolina

fibrostenotic

inflammatory

mixed

dysphagia

age predictors

treatment strategies