Progression from an Inflammatory to a Fibrostenotic Phenotype in Eosinophilic Esophagitis - PubMed (original) (raw)
Case Reports
. 2017 Jun 15;11(2):382-388.
doi: 10.1159/000477391. eCollection 2017 May-Aug.
Affiliations
- PMID: 29033756
- PMCID: PMC5637006
- DOI: 10.1159/000477391
Case Reports
Progression from an Inflammatory to a Fibrostenotic Phenotype in Eosinophilic Esophagitis
Nathaniel T Koutlas et al. Case Rep Gastroenterol. 2017.
Abstract
Previous studies have suggested that eosinophilic esophagitis (EoE) progresses from chronic inflammation to fibrostenosis. However, natural history data illustrating this progression in individual patients are lacking. Here, we present 6 patients who progressed from an inflammatory to a fibrostenotic phenotype of EoE in the absence of treatment. At the time of diagnosis, none of the patients had significant evidence of fibrostenosis, but they did have other inflammatory findings of EoE such as edema, linear furrows, or exudates. After being lost to follow-up and treatment for an average of 7.8 ± 2.0 years, strictures (n = 5; 83%) or a small-caliber esophagus (n = 4; 67%) were present in a majority of the patients, and the majority required esophageal dilation. These cases confirm that EoE can progress from an inflammation-only phenotype to a fibrostenotic phenotype in certain patients.
Keywords: Dilation; Eosinophilic esophagitis; Natural history; Progression; Stricture.
Figures
Fig. 1
a Initial endoscopic appearance of case 1, showing edema and furrows but a patent lumen. b Follow-up endoscopic appearance of case 1, demonstrating rings and narrowing, as well as furrows, plaques, and edema. c Baseline endoscopic appearance of case 3, showing edema and mild rings. d Follow-up endoscopy of case 3, showing tight rings and marked narrowing, as well as edema and furrows. e First endoscopic appearance of case 6, showing edema and furrows, but no narrowing, rings, or stricture. f On follow-up, case 6 now had narrowing and prominent rings, as well as persistent edema.
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References
- Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras C, Katzka DA. ACG clinical guideline: evidence based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE) Am J Gastroenterol. 2013;108:679–692. quiz 693. - PubMed
- Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128:3–20. e6; quiz 21–22. - PubMed
- Schoepfer AM, Safroneeva E, Bussmann C, Kuchen T, Portmann S, Simon HU, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology. 2013;145:1230–1236. e1–2. - PubMed
- Lipka S, Kumar A, Richter JE. Impact of diagnostic delay and other risk factors on eosinophilic esophagitis phenotype and esophageal diameter. J Clin Gastroenterol. 2016;50:134–140. - PubMed
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