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Adults with EoE have positive long-term outcomes after diagnosis
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LAS VEGAS — Ten years after initial diagnosis of eosinophilic esophagitis, most adults with the disease have resolution of symptoms and minimal impacts on quality of life, according to a retrospective study presented at ACG 2016.
“There is limited data on the long-term follow-up of adults ... however in children with EoE, 8 years after initial diagnosis ... approximately 80% demonstrated favorable outcomes,” Alexander Podboy, MD, from the Mayo Clinic, said during his presentation. “So our aim was to assess both symptoms and quality of life 10 years after initial diagnosis in adult patients with EoE.”
Podboy and colleagues performed a retrospective cohort study of 59 adults who had EoE for at least 10 years (mean age, 56.2 years; 66.1% men). At their initial diagnosis, 57.6% of the patients were treated with topical steroids and 33.9% were treated with proton pump inhibitors.
Ten years later, 31% were not on EoE therapy, 63.8% were taking PPIs, and only 6.8% were taking steroids. Most of the patients had not had an additional esophagogastroduodenoscopy since their original diagnosis, and only two patients required emergent food disimpaction.
During the last month of follow-up, 71.2% reported no difficulty swallowing, while 28.8% did report difficulty swallowing. Moreover, 62.5% reported eating an unlimited diet without caution, while 25% reported eating an unlimited diet with some caution, “with caution indicating excessive amounts of chewing, time, or fluids with their meals,” Podboy said. In addition, 7.1% of patients reported avoiding stringy meats and 3.6% reported avoiding bread.
Finally, reduced EoE-related quality of life was trivial to minimal in 57% of patients, mild in 18%, moderate in 16% and severe in 9%.
“After 10 years, two patients required emergent food disimpaction, 6.8% of patients were on swallowed steroid therapy, 65% reported no current symptoms, 62% had unlimited to unlimited with caution diet, and 75% reported a trivial to mild decrease in quality of life,” Podboy said. “EoE after initial diagnosis may be more benign than the literature suggests, and further evaluation is warranted to assess the need for long-term medical care.” – by Adam Leitenberger
Reference:
Podboy A, et al. Abstract #5. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 17-19, 2016; Las Vegas, NV.
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Evan S. Dellon, MD, MPH
In this study, researchers looked for patients who were diagnosed at least 10 years ago with EoE, and then they contacted them in the present and carefully assessed their symptoms, quality of life and dietary and food-related behaviors to see how they were doing. This is an important study because there are few long-term outcome and natural history data in EoE.
They reviewed a total database of about 850 EoE cases and in the end had about 75 who qualified, but they were able to contact and obtain data from 59 of them. Among those patients, many had been treated with topical steroids for relatively short courses years ago, and some had been treated with PPIs.
At the present time, the minority (just under 7%) were currently treated with topical steroids, and the majority (about two-thirds) were treated with PPIs. When asked about their symptoms, the majority of patients had either mild symptoms or weren't bothered at all by symptoms. The majority were also eating a fully liberalized diet with minimal extra caution in their diet, and the majority had minimal impact on their quality of life.
These data suggest that possibly the longer-term course of EoE is more benign compared to what has been reported in some other studies, where if EoE is untreated for years, the result is development of strictures and fibrosis. Therefore, the present study is interesting and a little bit surprising based on what has been previously known. However, there are a couple of caveats in interpreting this study because their patients 10 years ago were not diagnosed with EoE according to the current guidelines, so a proportion of those patients may have been PPI responders. If that is the case, because the majority of patients are on PPIs now, that may provide an explanation as to why they're doing so well.
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