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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 766-775.e4 |
| Journal | Clinical Gastroenterology and Hepatology |
| Volume | 20 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2022 |
Funding
Funding The Consortium of Gastrointestinal Eosinophilic Disease Researchers (U54 AI117804) is part of the Rare Disease Clinical Research Network, an initiative of the Office of Rare Diseases Research, The National Center for Advancing Translational Sciences, and is funded through collaboration between The National Institute of Allergy and Infectious Diseases, The National Institute of Diabetes and Digestive and Kidney Diseases, and The National Center for Advancing Translational Sciences. The Consortium of Gastrointestinal Eosinophilic Disease Researchers also is supported by patient advocacy groups including the American Partnership for Eosinophilic Disorders, the Campaign Urging Research for Eosinophilic Diseases, and the Eosinophilic Family Coalition. As a member of the Rare Disease Clinical Research Network, the Consortium of Gastrointestinal Eosinophilic Disease Researchers also is supported by its Data Management and Coordinating Center (U2CTR002818). This work also is supported by a grant from the Swiss National Science Foundation, Switzerland (project: 32473B_185008) (E.S.). La Cache Chair for GI Allergy and Immunology Research (G.T.F.). Conflicts of interest These authors disclose the following: Ekaterina Safroneeva has received consulting fees from AVIR Pharma, Inc, Aptalis Pharma, Inc, Celgene Corp, Novartis, AG, and Regeneron Pharmaceuticals, Inc; Eileen King is a former employee of Procter & Gamble Company and has stock and stock options in Procter & Gamble Company; Margaret H. Collins is a consultant for Allakos, Arena, Astra Zeneca, Calypso, Esocap, GSK, Receptos/BMS, Regeneron, Shire, a Takeda Company, and Robarts Clinical Trials, and has received research grants from Receptos/BMS, Regeneron, and Shire, a Takeda Company; Evan S. Dellon has received research funding from Adare, Allakos, GSK, Meritage, Miraca, Nutricia, Celgene/Receptos, Regeneron, and Shire/Takeda, consulting fees from Abbott, Adare, Aimmune, Allakos, Arena, AstraZeneca, Biorasi, Calypso, Celgene/Receptos, Eli Lilly, EsoCap, GSK, Gossamer Bio, Regeneron, Robarts, Salix, and Shire/Takeda, and educational grants from Allakos, Banner, and Holoclara; Gary W. Falk has received grants and consulting fees from Shire, ADARE/Ellodi, Regeneron, Allakos, Lucid, and Celgene; Nirmala Gonsalves receives consulting fees from Allakos and royalties from UpToDate; Sandeep K. Gupta has received personal fees from Allakos, Abbott, Receptos, QOL, and Shire; Ikuo Hirano has received research funding from Adare, Allakos, GSK, Meritage, Celgene/Receptos, Regeneron, and Shire/Takeda, and consulting fees from Adare, Allakos, Arena, AstraZeneca, Celgene/Receptos, Eli Lilly, EsoCap, GSK, Gossamer Bio, Regeneron, and Shire/Takeda; Vincent A. Mukkada has received research grants and consulting fees from Shire Pharmaceutical; Alain M. Schoepfer has received research grants and consulting fees from Adare Pharmaceuticals, Inc, AstraZeneca, AG, Switzerland, Aptalis Pharma, Inc, Celgene Corp, Dr. Falk Pharma, GmbH, Germany, Glaxo Smith Kline, AG, Nestlé S.A., Switzerland, Novartis, AG, Switzerland, Receptos, Inc, and Regeneron Pharmaceuticals, Inc; Jonathan M. Spergel has received grants from DBV Technologies, End Allergy Together, Aimmune Therapeutics, and Shire; he also received royalties from UpToDate, and personal fees from Regeneron, and Food Allergy Research Education; Barry K. Wershil has received speaker fees from Mead Johnson Nutrition and Abbott Nutritionals; Marc E. Rothenberg has received personal fees from Celgene, Astra Zeneca, Arena Pharmaceuticals, Adare Pharmaceuticals, GlaxoSmith Kline, Guidepoint, and Suvretta Capital Management, has an equity interest in Pulm One, Spoon Guru, ClostraBio, Serpin Pharm, and Allakos, receives royalties from reslizumab (Teva Pharmaceuticals), PEESSv2 (Mapi Research Trust), and UpToDate, and is an inventor of patents owned by Cincinnati Children's Hospital; Seema S. Aceves is a consultant for Regeneron, Astra-Zeneca, Astellos, and AImmune, and has a University of California San Diego patent licensed to Shire-Takeda Pharma; and Glenn T. Furuta is a founder and Chief Medical Officer of EnteroTrack; he received consulting fees from Shire/ Takeda and royalties from UpToDate. The remaining authors disclose no conflicts. Funding The Consortium of Gastrointestinal Eosinophilic Disease Researchers (U54 AI117804) is part of the Rare Disease Clinical Research Network, an initiative of the Office of Rare Diseases Research, The National Center for Advancing Translational Sciences, and is funded through collaboration between The National Institute of Allergy and Infectious Diseases, The National Institute of Diabetes and Digestive and Kidney Diseases, and The National Center for Advancing Translational Sciences. The Consortium of Gastrointestinal Eosinophilic Disease Researchers also is supported by patient advocacy groups including the American Partnership for Eosinophilic Disorders, the Campaign Urging Research for Eosinophilic Diseases, and the Eosinophilic Family Coalition. As a member of the Rare Disease Clinical Research Network, the Consortium of Gastrointestinal Eosinophilic Disease Researchers also is supported by its Data Management and Coordinating Center (U2CTR002818). This work also is supported by a grant from the Swiss National Science Foundation, Switzerland (project: 32473B_185008) (E.S.). La Cache Chair for GI Allergy and Immunology Research (G.T.F.).
Keywords
- Dysphagia
- Effect Modification
- Endoscopic Reference Score
- Eosinophilic Esophagitis Histologic Scoring System
- Eosinophilic Esophagitis-Specific Quality of Life in Adults
- Pain When Swallowing
ASJC Scopus subject areas
- Gastroenterology
- Hepatology