Aspects on the management of patients with eosinophilic esophagitis

Abstract

Eosinophilic esophagitis (EoE) is an inflammatory disorder of the esophagus characterized by symptoms of esophageal dysfunction and eosinophilia in the esophageal mucosa. This condition may affect approximately 1% of the general population and is strongly associated with allergy/atopic diatheses. Aims: The overall aim of this thesis was to examine the clinical aspects on the management of patients with EoE. The possibility of a seasonal variation of food bolus impaction in the esophagus, a common complication of EoE patients, was explored. The burden of symptoms and health-related quality of life (HRQL) of patients with EoE at diagnosis, after two months of treatment and at a long-term follow-up point were investigated. The association between the grade of mucosal eosinophilia and the symptoms was studied. Methods & Results: Subjects with bolus impaction (n=314) were included in a retrospective study. A significantly higher incidence of bolus impaction was found in subjects with atopic disorders during the fall (n=90) than during any of the other three seasons (p=0.015). Untreated EoE patients were included in two prospective studies (n=31 and n=47, respectively). Symptoms and HRQL (Watson Dysphagia Scale, EORTC QLQ-OES18, SF-36) were evaluated at diagnosis, after two months of treatment with topical corticosteroids and at least one year after inclusion (median: 23 months after inclusion). The dysphagia-related scores improved after treatment and a partial remission was noted at the long-term follow-up point. The grade of mucosal eosinophilia in untreated patients with dysphagia and esophageal eosinophilia (n=65) was assessed using both hematoxylin-eosin staining and immunohistochemical technique. No correlation was found between the grade of eosinophilia and the symptoms/HRQL using the aforementioned questionnaires, however, a higher grade of eosinophilia was found among patients with concomitant bolus impaction as compared to those without. Conclusions: A seasonal variation was found in the incidence of acute esophageal bolus impaction in patients with atopic disorders. EoE patients had a substantial burden of symptoms, which improved after treatment, and a partial remission was noted more than one year after diagnosis. A high grade of eosinophilia in the proximal part of the esophagus might serve as a marker for an increased risk of bolus impaction.