Long-Lasting Dissociation of Esophageal Eosinophilia and Symptoms After Dilation in Adults With Eosinophilic Esophagitis.

Ekaterina Safroneeva, Zhaoxing Pan, Eileen King, Lisa J Martin, Margaret H Collins, Guang-Yu Yang, Kelley E Capocelli, Nicoleta C Arva, J Pablo Abonia, Dan Atkins, Peter A Bonis, Evan S Dellon, Gary W Falk, Nirmala Gonsalves, Sandeep K Gupta, Ikuo Hirano, John Leung, Paul A Menard-Katcher, Vincent A Mukkada, Alain M Schoepfer, Jonathan M Spergel, Barry K Wershil, Marc E Rothenberg, Seema S Aceves, Glenn T Furuta

Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2022;20(4):766-775.e4

PMID: 34062314

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Abstract

BACKGROUND & AIMS

Esophageal dilation improves dysphagia but not inflammation in eosinophilic esophagitis (EoE) patients. We investigated if dilation modifies the association between symptoms and peak esophageal eosinophils per high-power field (eos/hpf).

METHODS

Adults enrolled in a multisite prospective Consortium of Gastrointestinal Eosinophilic Disease Researchers Outcome Measures for Eosinophilic Gastrointestinal Diseases Across Ages observational study (NCT02523118) completed the symptom-based EoE activity index (EEsAI) patient-reported outcome instrument and underwent endoscopy with biopsy specimens. Patients were stratified based on dilation status as absent, performed 1 year or less before endoscopy, and performed more than 1 year before endoscopy. Assessments included Spearman correlations of the relationship between symptoms and eos/hpf and linear regression with EEsAI as the outcome, eos/hpf as predictor, and interaction for dilation and eos/hpf.

RESULTS

Among 100 patients (n = 61 males; median age, 37 y), 15 and 40 patients underwent dilation 1 year or less and more than 1 year before index endoscopy, respectively. In nondilated patients, the association between eos/hpf and symptoms was moderate (ρ = 0.49; P < .001); for a 10-eos/hpf increase, the predicted EEsAI increased by 2.69 (P = .002). In patients dilated 1 or less and more than 1 year before index endoscopy, this association was abolished (ρ = -0.38; P = .157 for ≤1 y and ρ = 0.02; P = .883 >1 y); for a 10-eos/hpf increase, the predicted EEsAI changed by -1.64 (P = .183) and 0.78 (P = .494), respectively. Dilation modified the association between symptoms and eos/hpf (P = .005 and P = .187 for interaction terms of eos/hpf and dilation 1 or less years before and more than 1 year before index endoscopy, respectively).

CONCLUSIONS

In nondilated EoE adults, eos/hpf correlate modestly with symptoms; this correlation was no longer appreciated in dilated patients, and the dilation effects lasted longer than 1 year. Dilation status should be considered in studies evaluating EoE treatment and for clinical follow-up evaluation.

Address: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. Electronic address: [email protected].; Pediatric Gastroenterology, Pediatric Allergy and Immunology, Aurora, Colorado.; Division of Biostatistics and Epidemiology, Cincinnati, Ohio.; Division of Human Genetics, Cincinnati, Ohio.; Division of Pathology and Laboratory Medicine, Cincinnati, Ohio.; Division of Pathology, Chicago, Illinois.; Division of Pathology, Aurora, Colorado.; Department of Pathology and Laboratory Medicine, Chicago, Illinois.; Division of Allergy and Immunology, Department of Pediatrics, Cincinnati, Ohio.; Section of Allergy, Immunology, Aurora, Colorado.; Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts.; Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill School of Medicine, Chapel Hill, North Carolina.; Division of Gastroenterology, Philadelphia, Pennsylvania.; Division of Gastroenterology and Hepatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children/Indiana University School of Medicine, Indianapolis, Indiana.; Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado.; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.; Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.; Department of Allergy and Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.; Division of Allergy Immunology, University of California, San Diego, Rady Children's Hospital, San Diego, California.; Digestive Health Institute, Children's Hospital Colorado, Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Aurora, Colorado.

DOI: 10.1016/j.cgh.2021.05.049

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MeSH Terms: Adult, Dilatation, Endoscopy, Gastrointestinal, Eosinophilic Esophagitis, Humans, Male, Prospective Studies