The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis - PubMed (original) (raw)

The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis

Swathi Eluri et al. Gastrointest Endosc. 2016 Jun.

Erratum in

Erratum.
[No authors listed] [No authors listed] Gastrointest Endosc. 2016 Oct;84(4):755. doi: 10.1016/j.gie.2016.08.003. Gastrointest Endosc. 2016. PMID: 27633370 No abstract available.

Abstract

Background and aims: Some patients with eosinophilic esophagitis (EoE) have an extremely narrow esophagus, but the characteristics of this group have not been extensively described. We aimed to characterize the narrow-caliber phenotype of EoE, determine associated risk factors, and identify differences in treatment response in this subgroup of patients.

Methods: This retrospective cohort study from 2001 to 2014 included subjects with a new diagnosis of EoE per consensus guidelines. Demographic, endoscopic, histologic, and treatment response data were extracted from medical records. An extremely narrow-caliber esophagus was defined when a neonatal endoscope was required to traverse the esophagus due to the inability to pass an adult endoscope. Patients with and without an extremely narrow-caliber esophagus were compared. Multivariable logistical regression was performed to assess treatment outcomes.

Results: Of 513 patients with EoE, 46 (9%) had an extremely narrow-caliber esophagus. These patients were older (33 vs 22 years; P < .01), had longer symptom duration (11 vs 3 years; P < .01), more dysphagia (98% vs 66%; P < .01), and food impactions (53% vs 31%; P < .01). Dilation was more common with extreme narrowing (69% vs 17%; P < .01). Patients with a narrow-caliber esophagus were more refractory to steroid treatment, with lower symptom (56% vs 85%), endoscopic (52% vs 76%), and histologic (33% vs 63%) responses (P < .01 for all), and these differences persisted after multivariate analysis.

Conclusion: The extremely narrow-caliber esophagus is a more treatment-resistant subphenotype of EoE and is characterized by longer symptom duration and the need for multiple dilations. Recognition of an extremely narrow-caliber esophagus at diagnosis of EoE can provide important prognostic information.

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Figures

Figure 1

These images demonstrate the endoscopic appearance of the extreme narrow-caliber esophagus characterized by significant narrowing of the luminal diameter. All 3 images show the presence of esophageal rings and edema and also white plaques/exudates in the third image.

Figure 1

Comment in

Narrow-caliber esophagus of eosinophilic esophagitis: difficult to define, resistant to remedy.
Carlson DA, Hirano I. Carlson DA, et al. Gastrointest Endosc. 2016 Jun;83(6):1149-50. doi: 10.1016/j.gie.2016.01.034. Gastrointest Endosc. 2016. PMID: 27206583 Free PMC article. No abstract available.

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The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis - PubMed (original) (raw)