A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease.
A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease.
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DOI：
10.1016/j.gie.2013.10.027
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发表时间：
2014-04
影响因子：
7.7
通讯作者：
Shaheen NJ
中科院分区：
文献类型：
--
作者：
Dellon ES;Kim HP;Sperry SL;Rybnicek DA;Woosley JT;Shaheen NJ
嗜酸性粒细胞性食管炎（EoE）的表型尚未得到很好的表征。描述具有预定表型的EoE患者的临床特征，确定这些表型的预测因子，并对EoE的自然史进行推断。回顾性研究。三级护理中心。2001-2011年符合共识诊断指南的EoE事件病例。n/a内镜下表型，包括纤维狭窄、炎性或混合型。检查的其他临床特征包括特应性、食管嗜酸性粒细胞增多水平和症状发作年龄。多项logistic回归评估表型状态的预测因子。在379例EoE中，特应性状态或嗜酸性粒细胞增多水平无显著表型差异。炎性表型的患者比混合型或纤维狭窄的患者更可能年轻（分别为13岁、29岁和39岁; p<0.001），并且不太可能有吞咽困难、食物嵌塞和食管扩张（所有患者均p<0.001）。炎症患者诊断前的平均症状持续时间较短（5 vs 8 vs 8年; p=0.02）。多变量分析后，年龄和吞咽困难独立预测表型。年龄每增加10岁，纤维狭窄的OR为2.1（1.7-2.7）。吞咽困难的OR为7.0（2.6-18.6）。回顾性、单中心研究。在这个大的EoE队列中，纤维狭窄性疾病的可能性随着年龄的增长而显著增加。年龄每增加10岁，具有纤维狭窄EoE表型的几率增加一倍以上。这种关联表明EoE的自然病程是从炎症性疾病进展为纤维狭窄性疾病。
Phenotypes of eosinophilic esophagitis (EoE) are not well characterized. To describe clinical features of EoE patients with predefined phenotypes, determine predictors of these phenotypes, and make inferences about the natural history of EoE. Retrospective study. Tertiary care center. Incident EoE cases from 2001–2011 who met consensus diagnostic guidelines. n/a Endoscopic phenotypes, including fibrostenotic, inflammatory, or mixed. Other groups of clinical characteristics examined included atopy, level of esophageal eosinophilia, and age of symptom onset. Multinominal logistic regression assessed predictors of phenotype status. Of 379 cases of EoE identified, there were no significant phenotypic differences by atopic status or level of eosinophilia. Those with the inflammatory phenotype were more likely to be younger than those with mixed or fibrostenotic (13 vs 29 vs 39 years, respectively; p<0.001), and less likely to have dysphagia, food impaction, and esophageal dilation (p<0.001 for all). The mean symptom length prior to diagnosis was shorter for inflammatory (5 vs 8 vs 8 years; p=0.02). After multivariate analysis, age and dysphagia independently predicted phenotype. The OR for fibrostenosis for each 10-year increase in age was 2.1 (1.7–2.7). The OR for dysphagia was 7.0 (2.6–18.6). Retrospective, single-center study. In this large EoE cohort, the likelihood of fibrostenosing disease increased markedly with age. For every ten year increase in age, the odds of having a fibrostenotic EoE phenotype more than doubled. This association suggests that the natural history of EoE is a progression from an inflammatory to a fibrostenotic disease.