Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Swedish Digestive Health Institute, Swedish Health, Seattle, WA, USA.
Dis Esophagus. 2022 Dec 31;36(1). doi: 10.1093/dote/doac043.
Eosinophilic esophagitis (EoE) has been associated with autoimmune (AI) and connective tissue disorders (CTDs), but clinical correlates and treatment response to topical corticosteroids (tCS) for patients with both conditions are not well known. We aimed to determine the prevalence and clinical features of AI/CTDs in EoE patients, and assess the response to tCS. In this retrospective cohort study of adults and children newly diagnosed with EoE in the University of North Carolina EoE Clinicopathologic database, we extracted clinical characteristics and treatment response data. We compared EoE patients with and without AI/CTDs, identified independently associated factors, and explored treatment responses. Of 1029 EoE patients, 61 (5.9%) had an AI/CTDs. The most common AI/CTDs were psoriasis/psoriatic arthritis (P/PA) (1.7%), Hashimoto's (1.2%), and rheumatoid arthritis (RA) (1%). Compared to those without AI/CTDs, AI/CTDs patients were older (35 vs. 28 years, P = 0.004), more likely to be female (51% vs. 30%, P = 0.001), have insurance (93% vs. 78%, P = 0.004) and a longer symptom duration prior to EoE diagnosis (10 vs. 7 years, P = 0.02). Older age, female sex, having insurance, and having allergic rhinitis were independently associated with AI/CTDs. AI/CTD patients with EoE were less likely to have a symptom response (47% vs. 79%, P = 0.003). Overlap between EoE and AI/CTDs was uncommon, seen in approximately 6%, with P/PA, Hashimoto's, and RA being most frequent. In conclusion, older age, female sex, having insurance, and allergic rhinitis were independently associated with AI/CTDs. EoE patients with AI/CTDs had less symptom response, with trendtowards lower endoscopic and histologic responses, to tCS therapy.
嗜酸性食管炎（EoE）与自身免疫（AI）和结缔组织疾病（CTD）有关，但患有这两种疾病的患者使用局部皮质类固醇（tCS）的临床相关性和治疗反应尚不清楚。我们旨在确定 EoE 患者中 AI/CTD 的患病率和临床特征，并评估对 tCS 的反应。在北卡罗来纳大学 EoE 临床病理数据库中对新诊断为 EoE 的成人和儿童进行的这项回顾性队列研究中，我们提取了临床特征和治疗反应数据。我们比较了患有和不患有 AI/CTD 的 EoE 患者，确定了独立相关因素，并探讨了治疗反应。在 1029 名 EoE 患者中，有 61 名（5.9%）患有 AI/CTD。最常见的 AI/CTD 是银屑病/银屑病关节炎（P/PA）（1.7%）、桥本甲状腺炎（1.2%）和类风湿关节炎（RA）（1%）。与没有 AI/CTD 的患者相比，AI/CTD 患者年龄更大（35 岁比 28 岁，P=0.004），更有可能是女性（51%比 30%，P=0.001），有保险（93%比 78%，P=0.004），并且在 EoE 诊断之前症状持续时间更长（10 年比 7 年，P=0.02）。年龄较大、女性、有保险和过敏性鼻炎与 AI/CTD 独立相关。患有 EoE 的 AI/CTD 患者的症状缓解率较低（47%比 79%，P=0.003）。EoE 和 AI/CTD 之间的重叠并不常见，约占 6%，其中 P/PA、桥本甲状腺炎和 RA 最为常见。总之，年龄较大、女性、有保险和过敏性鼻炎与 AI/CTD 独立相关。患有 AI/CTD 的 EoE 患者的症状缓解率较低，对 tCS 治疗的内镜和组织学反应也呈下降趋势。
