The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis
The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis
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DOI：
10.1016/j.gie.2015.11.019
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发表时间：
2016-06-01
影响因子：
7.7
通讯作者：
Dellon, Evan S.
中科院分区：
文献类型：
--
作者：
Eluri, Swathi;Runge, Thomas M.;Dellon, Evan S.
背景和目标：一些嗜酸性食管炎（EoE）患者的食管非常狭窄，但这组患者的特征尚未得到广泛描述。我们的目的是描述EoE的窄口径表型，确定相关的风险因素，并确定在这个亚组patients.Methods治疗反应的差异：这项回顾性队列研究从2001年至2014年，包括受试者与一个新的诊断EoE每共识指南。从病历中提取人口统计学、内窥镜检查、组织学和治疗反应数据。当新生儿内窥镜由于无法通过成人内窥镜而需要穿过食管时，定义为极窄口径食管。比较了有和没有极窄口径食管的患者。进行多变量逻辑回归来评估治疗结果。结果：在513名EOE患者中，46名（9%）的食道口径极其狭窄。这些患者年龄较大（33比22岁; P < .01），症状持续时间较长（11比3年; P < .01），吞咽困难较多（98%比66%; P < .01），食物嵌塞较多（53%比31%; P < .01）。扩张在极度狭窄中更常见（69%对17%; P <0.01）。狭窄食管患者对类固醇治疗更难治，症状缓解率（56% vs 85%）、内镜缓解率（52% vs 76%）和组织学缓解率（33% vs 63%）较低（P
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