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Reed CC, LaFata SS, Gee TS, Thel HL, Cameron BA, Xue AZ, Kiran A, Ocampo AA, McCallen J, Lee CJ, Borinsky SA, Redd WD, Barlowe T, Kaakati RN, Cotton CC, Eluri S, Dellon ES. Daily or Twice Daily Treatment With Topical Steroids Results in Similar Responses in Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2025; 23:946-953.e1. [PMID: 39551254 PMCID: PMC12033081 DOI: 10.1016/j.cgh.2024.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 10/01/2024] [Accepted: 10/04/2024] [Indexed: 11/19/2024]
Abstract
BACKGROUND & AIMS Few data compare topical corticosteroid (tCS) dosing regimens and outcomes. We aimed to compare treatment outcomes in patients with eosinophilic esophagitis (EoE) by once or twice daily dosing regimens. METHODS We conducted a retrospective cohort study using the UNC EoE Clinicopathologic Database of newly diagnosed patients with EoE treated with a tCS who had a follow-up endoscopy with biopsy. Baseline data and outcomes were extracted. Bivariate and multivariate analyses compared patients at baseline and following initial tCS given as a once or twice daily dose. RESULTS A total of 522 patients met inclusion criteria, 122 patients on once daily dosing (72% male; 91% white) and 400 patients on twice daily dosing (66% male; 89% white). Patients on twice daily dosing were older (28.8 ± 18.2 vs 24.3 ± 18.0; P = .01) and reported more heartburn (40% vs 25%; P = .004). On bivariate analysis, global symptomatic response (78% vs 76%; P = .82), posttreatment eosinophil count (20.8 ± 27.2 vs 25.6 ± 39.4; P = .21), posttreatment EoE Endoscopic Reference Score (2.2 ± 1.8 vs 2.2 ± 2.0; P = .92), and histologic response (<15 eos/hpf; 56% vs 58%; P = .66) did not differ by dosing frequency. Candida was less frequent with daily dosing (2% vs 8%; P = .04). In multivariate analysis, the odds of histologic response did not differ by dose groups (adjusted odds ratio, 1.03; 95% confidence interval, 0.67-1.60). CONCLUSIONS EoE outcomes did not differ by daily or twice daily dosing regimens. These results inform tCS dosing regimens and reassure that both are effective.
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Affiliation(s)
- Craig C Reed
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sean S LaFata
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Timothy S Gee
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Hannah L Thel
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Brenderia A Cameron
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Angela Z Xue
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Akshatha Kiran
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Adolfo A Ocampo
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Justin McCallen
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Christopher J Lee
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephanie A Borinsky
- Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Walker D Redd
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Trevor Barlowe
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Rayan N Kaakati
- Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cary C Cotton
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Swathi Eluri
- Mayo Clinic Division of Gastroenterology and Hepatology, Jacksonville, Florida
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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Beveridge CA, Hermanns C, Thanawala S, Yang Q, Qin Y, Thota PN, Hoscheit M, Brown JM, Ivanov AI, Lembo A, Gabbard S, Rieder F. An Esophageal Luminal Diameter of 16 mm Predicts Dysphagia Resolution in Eosinophilic Esophagitis. Dig Dis Sci 2025; 70:1824-1831. [PMID: 40024960 DOI: 10.1007/s10620-025-08874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 01/15/2025] [Indexed: 03/04/2025]
Abstract
GOALS AND BACKGROUND Eosinophilic Esophagitis (EoE) is a chronic inflammatory esophageal disorder, often complicated by strictures requiring dilation. There is limited information on the target esophageal luminal diameter (ELD) post-treatment to relieve symptoms. The aim of this study was to determine the ELD threshold associated with dysphagia resolution in EoE patients in histologic remission. STUDY We performed a retrospective cohort study of adult EoE patients with a stricture in histologic remission. Patients were excluded if symptoms, EoE endoscopic reference score (EREFS), and ELD were missing. ELD was estimated by dilator diameter, endoscope passage, or functional lumen imaging probe. Symptoms, demographics, EREFS, and histology were recorded. Univariate and multivariable logistic regression analyses were performed. The ELD threshold for dysphagia was determined using receiver operating characteristics analyses. RESULTS Of the 76 patients who met criteria, 63 (82.9%) reported dysphagia. For every one-millimeter decrease in ELD, there was an increased odds of having dysphagia (OR 9.12, 95% CI 33.4, p < 0.001). The threshold ELD for having dysphagia was less than 16 mm (sensitivity: 96.8%, specificity: 92.3%). In a subcohort analysis of patients who were dilated (n = 58, 76.3%), the main predictor for persistent dysphagia post-dilation was the pre-dilation ELD (aOR 0.77, 95% CI 0.65-0.87, p < 0.001). CONCLUSION A decrease in ELD is associated with a higher odds of dysphagia in EoE patients in histologic remission. ELD of 16 mm or greater provided the strongest threshold for which symptoms were absent. This may present a reasonable dilation target.
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Affiliation(s)
- Claire A Beveridge
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Digestive Diseases Institute, Cleveland, OH, USA.
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, 2049 E. 100th Street, Crile, A Building, 3rd floor, Cleveland, OH, 44195, USA.
| | - Christina Hermanns
- Department of Internal Medicine, Cleveland Clinic, Community Care Institute, Cleveland, OH, USA
| | - Shivani Thanawala
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Qijun Yang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Yi Qin
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Digestive Diseases Institute, Cleveland, OH, USA
| | - Prashanthi N Thota
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Digestive Diseases Institute, Cleveland, OH, USA
| | - Matthew Hoscheit
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Digestive Diseases Institute, Cleveland, OH, USA
| | - J Mark Brown
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Center for Microbiome and Human Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrei I Ivanov
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anthony Lembo
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Digestive Diseases Institute, Cleveland, OH, USA
| | - Scott Gabbard
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Digestive Diseases Institute, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Digestive Diseases Institute, Cleveland, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Cleveland Clinic Program for Global Translational Inflammatory Bowel Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
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Beveridge CA, Hermanns C, Thanawala S, Chatterjee A, Sharma N, Vura NVRK, Yang Q, Qin Y, Thota P, Hoscheit M, Brown JM, Ivanov AI, Lembo A, Gabbard S, Rieder F. Predictors of persistent symptoms in eosinophilic esophagitis after remission: fibrostenosis, eosinophilia, anxiety, and depression. Dis Esophagus 2025; 38:doae110. [PMID: 39673363 DOI: 10.1093/dote/doae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 10/21/2024] [Accepted: 11/14/2024] [Indexed: 12/16/2024]
Abstract
Eosinophilic Esophagitis (EoE) is a chronic inflammatory esophageal disorder, often associated with dysphagia, chest discomfort, and heartburn. There is limited information on persistent esophageal symptoms despite histologic remission (HR). We aimed to assess the prevalence and predictors of persistent esophageal symptoms in adult patients with EoE in HR. We performed a retrospective cohort study of adult EoE patients in HR (<15 eosinophils per high power field [eos/hpf]). Exclusion criteria included: no available data on symptoms, chronic opiate use, disorders of esophagogastric junction outflow on Chicago Classification version 4 diagnosis, esophageal candidiasis, erosive esophagitis, or other known cause of esophageal dysphagia besides EoE. Based on prior literature, definitions include: complete HR (<5 eos/hpf), partial HR (5-14 eos/hpf), and endoscopic fibrostenosis (rings and/or stricture). Esophageal symptoms were assessed within 2 weeks of HR and categorized into the major symptoms of dysphagia, chest pain, and heartburn. Given the retrospective nature of the study, a global symptom response (absence or presence) was used. Demographics, disease history, endoscopy reports, EoE endoscopic reference score, and histology were recorded. Univariate and multivariable logistic regression analyses were performed. Eosinophil thresholds for persistent symptoms were determined using receiver operating characteristics analyses. Of 289 EoE patients in HR, 133 (46%) had esophageal symptoms: dysphagia (N = 119; 41.2%), heartburn (N = 28; 20.8%), and chest pain (N = 10; 7.5%). Significant predictors for persistent dysphagia were anxiety (adjusted odds ratio [aOR] 3.77) and endoscopic fibrostenosis (aOR 3.87). Significant predictors for persistent heartburn with or without chest pain were anxiety or depression (aOR 12.2 and aOR 11.0) and partial HR (aOR 1.17 and aOR 1.18). Threshold eosinophil counts for persistent heartburn and chest pain were 2.5 and 3.5 eos/hpf, respectively (AUC 0.71 and 0.69). We report a high prevalence of persistent esophageal symptoms in EoE patients who are in HR. Risk factors include anxiety, depression, endoscopic fibrostenosis, and partial HR. These findings can help direct patient care, including endoscopic dilation and managing psychiatric comorbidities. Targeting less than 2.5 and 3.5 eos/hpf for heartburn and chest pain may be warranted.
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Affiliation(s)
- Claire A Beveridge
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christina Hermanns
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shivani Thanawala
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arjun Chatterjee
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Neha Sharma
- Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Qijun Yang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Yi Qin
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prashanthi Thota
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Hoscheit
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Mark Brown
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, OH, USA
| | - Andrei I Ivanov
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anthony Lembo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott Gabbard
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Dellon ES, Furuta GT, Tomeo N, Karavanov A, Smernoff Z, Harrington J, Aceves SS. Usability of a Mobile Point-of-Care App for the Index of Severity for Eosinophilic Esophagitis. GASTRO HEP ADVANCES 2024; 4:100604. [PMID: 40242170 PMCID: PMC12001112 DOI: 10.1016/j.gastha.2024.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 12/21/2024] [Indexed: 04/18/2025]
Abstract
Background and Aims A new application (app) allows the Index of Severity for EoE (I-SEE) to be used at the point of care. We aimed to perform usability testing of the I-SEE mobile app and identify areas for improvement. Methods We recruited 60 practitioners (20 adult and 20 pediatric gastroenterologists; 20 allergists) to use I-SEE on ≥5 EoE patients seen in clinic and undergo interviews by trained qualitative researchers. The interview guide focused on overall user experience, user satisfaction, and desired improvements. It also explored potential perceived barriers to using the app and I-SEE. Results Though I-SEE was new to most providers, they found it took only a few minutes to calculate the score. All interviewees either "agreed" (5%) or "strongly agreed" (95%) with the statement, "The app was easy to navigate," and almost all (95%) either "agreed" (42%) or "strongly agreed" (53%) with "The app's features and functionalities were intuitive and easy to understand". The large majority (85%) reported satisfaction with the app. Responses were similar for allergists, and adult and pediatric gastroenterologists. Areas of suggested improvement included updating design features, incorporation into electronic medical records, addressing if scoring for children and adults should be different, and clarifying clinical implications of I-SEE for management. Conclusion The I-SEE app was user friendly and able to be completed rapidly in clinical practice. Interviewee feedback led to app updates to improve visualization and use. In the future, scoring for children should be confirmed and I-SEE should be validated by linking severity to treatment and monitoring recommendations.
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Affiliation(s)
- Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Glenn T. Furuta
- Gastrointestinal Eosinophilic Diseases Program and Mucosal Inflammation Program, Department of Pediatrics, University of Colorado School of Medicine, Digestive Health Institute, Children’s Hospital Colorado, Aurora, Colorado
| | - Nick Tomeo
- American Gastroenterological Association, Bethesda, Maryland
| | | | | | | | - Seema S. Aceves
- Division of Allergy, Immunology, University of California San Diego and Rady Children’s Hospital, San Diego, California
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Kohley A, Attwal S, Jones SM, Akmyradov C, Chandler P, Tootle C, Nawaz S, Ayers T, Kawatu D, Pesek RD. Impact of Atopic Status on Clinical Presentation and Treatment Response in Pediatric Patients With Eosinophilic Esophagitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:3358-3362. [PMID: 39187155 DOI: 10.1016/j.jaip.2024.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/27/2024] [Accepted: 08/15/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Nearly 80% of patients with eosinophilic esophagitis (EoE) have coexisting atopic disease, yet a subset do not. It is unclear if this lack of atopy impacts presentation or response to therapy. OBJECTIVES To characterize the presentation and response to therapy in atopic versus nonatopic pediatric patients with EoE. METHODS A case-control study of patients with EoE aged 6 months to 18 years (between 2018 and 2021) was performed. Patients were eligible if they had allergy testing, assessment of atopic history, and at least 1 endoscopy after initiation of treatment. Patients were considered nonatopic if they had negative allergy testing and no history of significant atopy. Response to therapy was classified as complete (peak eosinophils [eos] <15/high power field [hpf]), partial (≥15 eos/hpf but at least a 50% reduction in peak eos), or nonresponse. RESULTS A total of 168 participants were enrolled. The majority were White (n = 141, 84%), male (n = 124, 74%), and non-Hispanic (n = 158, 95%). The mean age at diagnosis was 9.4 years (standard deviation: ±4.8 years). A total of 123 participants (73.2%) were atopic, and 45 (26.8%) were nonatopic. There was no significant difference between atopic and nonatopic for most demographics or presenting symptoms. Nonatopic participants were younger than atopic participants (8.14 vs 9.8 years, P = .046). Swallowed topical corticosteroids (STC) and food elimination diets (FED) were used at a similar rate. There were no differences in treatment response between atopic/nonatopic participants in regard to STC, FED, or STC+FED. CONCLUSIONS Atopic status does not significantly impact presentation or response to treatment in pediatric EoE, but a lack of atopy may be a risk for earlier onset of disease.
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Affiliation(s)
- Annalyse Kohley
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Safin Attwal
- Division of Allergy and Immunology, Arkansas Children's Hospital, Little Rock, Ark
| | - Stacie M Jones
- Division of Allergy and Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Chary Akmyradov
- Department of Biostatistics, Arkansas Children's Hospital, Little Rock, Ark
| | - Peggy Chandler
- Division of Allergy and Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Christina Tootle
- Division of Pediatric Gastroenterology, Department of Pediatrics, Arkansas Children's Hospital and the University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Safia Nawaz
- Division of Allergy and Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Travis Ayers
- Division of Pediatric Gastroenterology, Department of Pediatrics, Arkansas Children's Hospital and the University of Arkansas for Medical Sciences, Little Rock, Ark
| | - David Kawatu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Arkansas Children's Hospital and the University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Robbie D Pesek
- Division of Allergy and Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark.
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McCallen JD, Dave M, LaFata S, Cameron BA, Xue AZ, Kiran A, Ocampo AA, Lee CJ, Borinsky SA, Redd WD, Cotton CC, Eluri S, Reed CC, Dellon ES. Topical Steroids Are Effective and Safe in Patients With Eosinophilic Esophagitis Over a Median of 6.5 Years of Chronic Use. J Clin Gastroenterol 2024:00004836-990000000-00355. [PMID: 39365834 PMCID: PMC11973234 DOI: 10.1097/mcg.0000000000002081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 09/12/2024] [Indexed: 10/06/2024]
Abstract
GOALS To determine long-term efficacy and safety of tCS for treatment of EoE. BACKGROUND Maintenance therapy with topical corticosteroids (tCS) is recommended for eosinophilic esophagitis (EoE), but data for long-term use are still needed. STUDY This retrospective cohort study assessed newly diagnosed patients with EoE who were treated with a tCS and had a follow-up endoscopy with biopsy after at least 5 years. Histologic symptomatic and endoscopic responses were extracted from medical records. Patients who did and did not have long-term tCS treatment were compared at baseline, and outcomes for patients were assessed at their last endoscopy while on tCS. RESULTS Of 431 patients with EoE treated with tCS, 104 met inclusion criteria for long-term use. For patients with long-term tCS use, the median time (IQR) on tCS was 6.5 years (5.4 to 8.8 y). At the last endoscopy, 54% had histologic response (<15 eos/hpf), but those with excellent adherence had a histologic response of 64%. Endoscopic severity also decreased with improved adherence which was strongly associated with EREFS (1.7 vs. 2.8 vs. 4.0 for excellent, good, and poor adherence; P<0.001). Symptomatic response was 68% overall, but only 40% in those with poor adherence (P=0.07). Complications of taking tCS were uncommon (adrenal insufficiency: 1%; osteopenia: 1%; and esophageal candidiasis: 4% at final endoscopy). CONCLUSIONS Long-term tCS (median 6.5 y) were generally effective, especially with better adherence, and also safe, with only rare serious complications. These data can be used to help patients make clinical decisions about chronic tCS use in EoE.
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Affiliation(s)
- Justin D. McCallen
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mili Dave
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sean LaFata
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Brenderia A. Cameron
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Angela Z. Xue
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Akshatha Kiran
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Adolfo A. Ocampo
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Christopher J. Lee
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Stephanie A. Borinsky
- Pediatric Gastroenterology, Department of Pediatrics; University of North Carolina School of Medicine, Chapel Hill, NC
| | - Walker D. Redd
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Cary C. Cotton
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Swathi Eluri
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Craig C. Reed
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
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Burk CM, Shreffler WG. Triggers for eosinophilic esophagitis (EoE): The intersection of food allergy and EoE. J Allergy Clin Immunol 2024; 153:1500-1509. [PMID: 38849185 PMCID: PMC11414349 DOI: 10.1016/j.jaci.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 06/09/2024]
Abstract
Eosinophilic esophagitis and IgE-mediated food allergy are both food-triggered diseases that are increasing in prevalence. They share many clinical links, including significant comorbidity and similar food triggers, and as atopic diseases, they likely share upstream mechanisms related to barrier function and signals leading to TH2 skewing. In this review, we focus on links between eosinophilic esophagitis and IgE-mediated food allergy with an emphasis on what insights may be derived from overlapping food triggers and immune phenotypes. Through further investigation of these connections, we may be able to better understand not only IgE-mediated food allergy and eosinophilic esophagitis but also general atopic response to food proteins and evolution of allergic response to food.
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Affiliation(s)
- Caitlin M Burk
- Food Allergy Center, Division of Pediatric Allergy and Immunology, and Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Mass.
| | - Wayne G Shreffler
- Food Allergy Center, Division of Pediatric Allergy and Immunology, and Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Mass
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