Delay in Diagnosis of Eosinophilic Esophagitis Increases Risk for Stricture Formation in a Time-Dependent Manner

被引:571
作者
Schoepfer, Alain M. [1 ]
Safroneeva, Ekaterina [2 ]
Bussmann, Christian [3 ]
Kuchen, Tanja [4 ]
Portmann, Susanne [5 ]
Simon, Hans-Uwe [6 ]
Straumann, Alex [7 ]
机构
[1] CHU Vaudois, Div Gastroenterol & Hepatol, CH-1011 Lausanne, Switzerland
[2] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
[3] Viollier AG, Inst Pathol, Basel, Switzerland
[4] Univ Zurich Hosp, Div Gastroenterol & Hepatol, CH-8091 Zurich, Switzerland
[5] Kantonsspital Baden, Div Gastroenterol & Hepatol, Baden, Switzerland
[6] Univ Bern, Inst Pharmacol, Bern, Switzerland
[7] Univ Basel Hosp, Div Gastroenterol & Hepatol, CH-4031 Basel, Switzerland
基金
瑞士国家科学基金会;
关键词
Esophagus; Complications; Inflammation; Remodeling; CONSENSUS RECOMMENDATIONS; FOOD IMPACTION; ADULT PATIENTS; CHILDREN; INFLAMMATION; BUDESONIDE; ADOLESCENT;
D O I
10.1053/j.gastro.2013.08.015
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND & AIMS: Development of strictures is a major concern for patients with eosinophilic esophagitis (EoE). At diagnosis, EoE can present with an inflammatory phenotype (characterized by whitish exudates, furrows, and edema), a stricturing phenotype (characterized by rings and stenosis), or a combination of these. Little is known about progression of stricture formation; we evaluated stricture development over time in the absence of treatment and investigated risk factors for stricture formation. METHODS: We performed a retrospective study using the Swiss EoE Database, collecting data on 200 patients with symptomatic EoE (153 men; mean age at diagnosis, 39 +/- 15 years old). Stricture severity was graded based on the degree of difficulty associated with passing of the standard adult endoscope. RESULTS: The median delay in diagnosis of EoE was 6 years (interquartile range, 2-12 years). With increasing duration of delay in diagnosis, the prevalence of fibrotic features of EoE, based on endoscopy, increased from 46.5% (diagnostic delay, 0-2 years) to 87.5% (diagnostic delay, >20 years; P=.020). Similarly, the prevalence of esophageal strictures increased with duration of diagnostic delay, from 17.2% (diagnostic delay, 0-2 years) to 70.8% (diagnostic delay, >20 years; P<.001). Diagnostic delay was the only risk factor for strictures at the time of EoE diagnosis (odds ratio = 1.08; 95% confidence interval: 1.040-1.122; P<.001). CONCLUSIONS: The prevalence of esophageal strictures correlates with the duration of untreated disease. These findings indicate the need to minimize delay in diagnosis of EoE.
引用
收藏
页码:1230 / +
页数:9
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