Oude Nijhuis, R.A.B. (2017) The Natural History of Eosinophilic Esophagitis and the long-term consequences of untreated disease. thesis, Medicine.
Full text available on request.Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disorder of the esophagus, characterized by an eosinophilic infiltration of the esophageal epithelium and by symptoms of esophageal dysfunction. The clinical presentation can vary with age. At initial diagnosis, EoE can present with typical inflammatory and/or fibrotic endoscopic features. Strictures and food impactions that require endoscopic dislodgement (ED) of the bolus are thought to be major EoE-related complications and have considerable consequences for the patient. Despite increasing interest in EoE, little is known about the natural history of disease. Whether these long-term complications relate to the duration of untreated disease has not been investigated in large nationwide cohorts. AIM To evaluate differences in disease presentation between children and adults, and the relationship between duration of untreated disease and the occurrence of strictures, endoscopic features and food bolus impactions (ED). METHODS We conducted a retrospective study of 721 patients (524 males, 117 children (≤18 years), mean age at diagnosis 36±18 years) diagnosed between 1996–2015, from fifteen collaborating hospitals in the Netherlands. All patients met the clinicopathological diagnosis of EoE. Histologic, endoscopic and clinical features associated with EoE were identified and stratified by diagnostic delay, as indicator of untreated disease, and age. RESULTS The majority of adults presented with dysphagia (91%) or symptoms of food impaction (73%), whereas in children more nonspecific symptoms predominated, including regurgitation, vomiting and abdominal pain (all p<0.001). The prevalence of fibrotic endoscopic features was significantly higher in adults (76%) than in children (39%) (p<0.001). The mean diagnostic delay was 7±8 years. The prevalence of fibrotic features increased with prolonged duration of diagnostic delay from 56% (≤2 years of diagnostic delay) to 92% (≥21 years diagnostic delay). Likewise, prevalence of strictures (from 19% to 52%) and food impactions (ED) (from 24% to 57%) increased as duration of untreated disease increased (all p<0.001). A diagnostic delay of ≥ 5 years (odds ratio (OR) = 3.5; 95% confidence interval (CI) = 2.3-5.4) and male gender (OR=2.5; 95% CI=1.5-4.1) were identified as risk factors for stricture formation. CONCLUSION EoE can occur at all ages, but differs significantly in clinical and endoscopic presentation between children and adults. EoE evolves into a fibrostenotic disease over time and the risk of strictures and food bolus impactions (ED) increases as untreated disease persists. These findings underlie the importance of early disease detection and maintenance therapy in all EoE patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | FIRST SUPERVISOR and Kolkman, Prof. dr. J.J. Medisch Spectrum Twente |
| Supervisor name: | SECOND SUPERVISORS and Bredenoord, Dr. AJ..& and Warners, M.J. and LOCATION and Gastroenterology and hepatology, Academic Medical Center |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:44 |
| Last Modified: | 25 Jun 2020 10:44 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/571 |
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