Eosinophilic Esophagitis Might Progress from Inflammatory to Fibrostenotic Disease

Chris E. Forsmark, MD

Supporting this conclusion was an observed twofold increased risk for fibrostenotic phenotype with each 10-year increase in age.

The optimal type and duration of treatment for eosinophilic esophagitis (EoE) remain unknown. In particular, the need for and effect of chronic or maintenance therapy in preventing long-term complications is unclear. However, multiple phenotypes of EoE have been described and might represent different clinical variants, possibly influencing treatment and outcomes. In the current retrospective analysis, investigators from a single tertiary center described clinical features of 374 patients with different endoscopic phenotypes of EoE.

Mean age at diagnosis was 25 years (range, 0.5–82 years). Endoscopic phenotypes were fibrostenotic (marked by esophageal rings, narrowing, or stricture without linear furrows or white plaques), inflammatory (marked by furrows or plaques or normal-appearing), and mixed (combinations of these findings).

Results included the following:

Phenotype distribution was: fibrostenotic, 21%; inflammatory, 36%; and mixed, 43%.

Patients with fibrostenotic phenotype were much older than those in the inflammatory group (difference in mean age, 26 years) and were much more likely to present with food impaction and require esophageal dilation.

The risk for fibrostenotic disease doubled with each 10-year increase in age.

Patients with inflammatory phenotype were more likely to present with abdominal pain, vomiting, or failure to thrive.

In patients with fibrostenotic and mixed phenotypes, time to diagnosis after onset of symptoms was longer than in patients with inflammatory disease.

Citation(s):

Dellon ES et al. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc 2013 Nov 25; [e-pub ahead of print].