Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Allergy. 2014 Sep;69(9):1248-54. doi: 10.1111/all.12455. Epub 2014 Jul 3.
Long-lasting food impactions requiring endoscopic bolus removal occur frequently in patients with eosinophilic esophagitis (EoE) and harbor a risk for severe esophageal injuries. We evaluated whether treatment with swallowed topical corticosteroids is able to reduce the risk of occurrence of this complication.
We analyzed data from the Swiss EoE Cohort Study. Patients with yearly clinic visits, during which standardized assessment of symptoms, endoscopic, histologic, and laboratory findings was carried out, were included.
A total of 206 patients (157 males) were analyzed. The median follow-up time was 5 years with a total of 703 visits (mean 3.41 visits/patient). During the follow-up period, 33 patients (16 % of the cohort) experienced 42 impactions requiring endoscopic bolus removal. We evaluated the following factors regarding the outcome 'bolus impaction' by univariate logistic regression modeling: swallowed topical corticosteroid therapy (OR 0.503, 95%-CI 0.255-0.993, P = 0.048), presence of EoE symptoms (OR 1.150, 95%-CI 0.4668-2.835, P = 0.761), esophageal stricture (OR 2.832, 95%-CI 1.508-5.321, P = 0.001), peak eosinophil count >10 eosinophils/HPF (OR 0.724, 95%-CI 0.324-1.621, P = 0.433), blood eosinophilia (OR 1.532, 95%-CI 0.569-4.118, P = 0.398), and esophageal dilation (OR 1.852, 95%-CI 1.034-3.755, P = 0.017). In the multivariate model, the following factors were significantly associated with bolus impaction: swallowed topical corticosteroid therapy (OR 0.411, 95%-CI 0.203-0.835, P = 0.014) and esophageal stricture (OR 2.666, 95%-CI 1.259-5.645, P = 0.01). Increasing frequency of use of swallowed topical steroids was associated with a lower risk for bolus impactions.
Treatment of EoE with swallowed topical corticosteroids significantly reduces the risk for long-lasting bolus impactions.
需要内镜球囊清除的长期食物嵌塞在嗜酸性食管炎（EoE）患者中经常发生，并存在严重食管损伤的风险。我们评估了口服局部皮质类固醇治疗是否能够降低这种并发症发生的风险。
我们分析了瑞士 EoE 队列研究的数据。纳入了每年进行临床就诊的患者，在此期间进行了症状、内镜、组织学和实验室检查的标准化评估。
共分析了 206 名患者（157 名男性）。中位随访时间为 5 年，共进行了 703 次随访（平均每位患者 3.41 次）。在随访期间，33 名患者（队列的 16%）经历了 42 次需要内镜球囊清除的嵌塞。我们通过单变量逻辑回归模型评估了以下因素与“球囊嵌塞”结局的关系：口服局部皮质类固醇治疗（OR 0.503，95%CI 0.255-0.993，P=0.048）、EoE 症状存在（OR 1.150，95%CI 0.4668-2.835，P=0.761）、食管狭窄（OR 2.832，95%CI 1.508-5.321，P=0.001）、峰值嗜酸性粒细胞计数>10 个/高倍视野（OR 0.724，95%CI 0.324-1.621，P=0.433）、血嗜酸性粒细胞增多（OR 1.532，95%CI 0.569-4.118，P=0.398）和食管扩张（OR 1.852，95%CI 1.034-3.755，P=0.017）。在多变量模型中，以下因素与球囊嵌塞显著相关：口服局部皮质类固醇治疗（OR 0.411，95%CI 0.203-0.835，P=0.014）和食管狭窄（OR 2.666，95%CI 1.259-5.645，P=0.01）。口服局部皮质类固醇的使用频率增加与球囊嵌塞的风险降低相关。
EoE 的口服局部皮质类固醇治疗可显著降低长期球囊嵌塞的风险。
