Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Gastroenterology. 2021 Oct;161(4):1133-1144. doi: 10.1053/j.gastro.2021.06.023. Epub 2021 Jun 19.
BACKGROUND & AIMS: Patient symptom reporting often does not correlate with the pathophysiological markers of esophageal disease, including eosinophilic esophagitis (EoE). Esophageal hypervigilance and symptom-specific anxiety are emerging as important considerations in understanding symptom reporting. As such, we aimed to conduct the first study of these constructs in EoE.
A retrospective review of an EoE patient registry was conducted and included eosinophils per high power field (from esophagogastroduodenoscopy biopsy: proximal, distal), endoscopic reference score, distal distensibility plateau (functional luminal imaging probe), Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, Northwestern Esophageal Quality of Life scale, and the Esophageal Hypervigilance and Anxiety Scale. Correlational and regression analyses evaluated relationships of hypervigilance and anxiety with Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, and Northwestern Esophageal Quality of Life scale when controlling for histology and endoscopic severity.
One hundred and three patients had complete data, 69.9% were male, and the mean (SD) age was 40.66 (13.85) years. Forty-one percent had elevated dysphagia and 46% had elevated hypervigilance and anxiety. Esophageal symptom-specific anxiety emerged as the most important predictor of Brief Esophageal Dysphagia Questionnaire severity (44.8% of the variance), Visual Dysphagia Question of EoE Activity Index severity (26%), and poor health-related quality of life (HRQoL) (55.3%). Hypervigilance was also important, but to a lesser extent. Pathophysiological variables did not significantly predict symptoms or HRQoL. Recent food impaction can predict symptom-specific anxiety and proton pump inhibitor use can reduce hypervigilance.
Hypervigilance and symptom-specific anxiety are important for our understanding of self-reported patient outcomes in EoE. These processes outweigh endoscopic and histologic markers of EoE disease activity across dysphagia, difficulty eating, and HRQoL. Clinicians should assess hypervigilance and anxiety, especially in patients with refractory symptoms and poor HRQoL.
患者症状报告通常与食管疾病的病理生理标志物无关,包括嗜酸性食管炎(EoE)。食管过度警觉和症状特异性焦虑是理解症状报告的重要考虑因素。因此,我们旨在首次研究这些 EoE 中的结构。
对 EoE 患者登记处进行回顾性审查,包括高倍视野下的嗜酸性粒细胞数(来自食管胃十二指肠镜活检:近端、远端)、内镜参考评分、远端扩张平台(功能腔内成像探头)、简要食管吞咽困难问卷、EoE 活动指数的视觉吞咽困难问卷、西北食管生活质量量表和食管过度警觉和焦虑量表。相关性和回归分析评估了在控制组织学和内镜严重程度的情况下,过度警觉和焦虑与简要食管吞咽困难问卷、EoE 活动指数的视觉吞咽困难问卷和西北食管生活质量量表之间的关系。
103 名患者有完整的数据,69.9%为男性,平均(SD)年龄为 40.66(13.85)岁。41%的患者有吞咽困难,46%的患者有过度警觉和焦虑。食管症状特异性焦虑是简要食管吞咽困难问卷严重程度的最重要预测因素(占 44.8%),EoE 活动指数严重程度(占 26%)和健康相关生活质量(HRQoL)较差(占 55.3%)。过度警觉也很重要,但程度较小。生理变量不能显著预测症状或 HRQoL。最近的食物嵌塞可预测症状特异性焦虑,质子泵抑制剂的使用可降低过度警觉。
过度警觉和症状特异性焦虑对于我们理解 EoE 患者自我报告的患者结局非常重要。这些过程在吞咽困难、进食困难和 HRQoL 方面超过了 EoE 疾病活动的内镜和组织学标志物。临床医生应评估过度警觉和焦虑,尤其是在有难治性症状和 HRQoL 较差的患者中。