Snyder Diana L, Alexander Jeffrey A, Ravi Karthik, Fidler Jeff L, Katzka David A
Division of Gastroenterology, Mayo Clinic Rochester, Rochester, Minnesota.
Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota.
Gastro Hep Adv. 2024 Jan 24;3(4):448-453. doi: 10.1016/j.gastha.2024.01.010. eCollection 2024.
A key unknown in eosinophilic esophagitis (EoE) is the long-term course of esophageal stenosis. Our aim was to evaluate the course of esophageal strictures using structured serial esophagrams and determine predictors of diameter improvement in patients with EoE.
This was a retrospective study of 78 EoE patients who completed 2 structured esophagrams at an academic tertiary referral center between 2003 and 2021. Maximum and minimum esophageal diameters were measured during esophagram using a standardized protocol to reduce measurement errors.
The median age at first esophagram was 36.2 (12.9-64.3) years; 60.3% of patients were male; 41 patients had active EoE; and 9 were inactive. Of the patients, 39.7% had allergic rhinitis, asthma (32.1%), and atopic dermatitis (7.7%). Medical therapies at second esophagram and esophagogastroduodenoscopy included proton pump inhibitors (39.5%), swallowed topical steroids (31.6%), diet elimination (13.2%), biologic therapies (1.3%), and clinical trial medications (1.3%). Median maximum diameter significantly increased by 1.0 mm (Q1: -1.0 mm, Q3: 3.0 mm) ( = .034), independent of dilation ( = .744). Increase was most profound in patients starting in the lowest maximum diameter group (9-15 mm) with median increase of 3.0 mm. For patients in disease remission at the second esophagram, there was a significant increase in maximum diameter per year compared to active disease at 0.8 mm (Q1: 0.0 mm, Q3: 5.3 mm) and 0.0 mm (Q1: -0.4 mm, Q3: 0.6 mm) respectively ( = .019).
Long-term improvement in esophageal strictures in patients with EoE may occur but is modest and likely occurs over years. Progression also appears to be minimal. Continuous medical treatment may reduce the rate of stricture recurrence and may improve stricture diameter over time.
嗜酸性粒细胞性食管炎（EoE）中一个关键的未知因素是食管狭窄的长期病程。我们的目的是使用结构化系列食管造影评估食管狭窄的病程，并确定EoE患者食管直径改善的预测因素。
这是一项对78例EoE患者的回顾性研究，这些患者于2003年至2021年在一家学术性三级转诊中心完成了2次结构化食管造影。在食管造影期间，使用标准化方案测量食管的最大和最小直径，以减少测量误差。
首次食管造影时的中位年龄为36.2（12.9 - 64.3）岁；60.3%的患者为男性；41例患者患有活动性EoE，9例为非活动性。在这些患者中，39.7%患有过敏性鼻炎，32.1%患有哮喘，7.7%患有特应性皮炎。第二次食管造影和食管胃十二指肠镜检查时的医学治疗包括质子泵抑制剂（39.5%）、吞咽局部类固醇（31.6%）、饮食排除（13.2%）、生物治疗（1.3%）和临床试验药物（1.3%）。中位最大直径显著增加1.0 mm（第一四分位数：-1.0 mm，第三四分位数：3.0 mm）（P = 0.034），与扩张无关（P = 0.744）。在起始最大直径组最低（9 - 15 mm）的患者中增加最为显著，中位增加3.0 mm。对于在第二次食管造影时处于疾病缓解期的患者，与活动性疾病相比，最大直径每年分别显著增加0.8 mm（第一四分位数：0.0 mm，第三四分位数：5.3 mm）和0.0 mm（第一四分位数：-0.4 mm，第三四分位数：0.6 mm）（P = 0.019）。
EoE患者食管狭窄可能会有长期改善，但程度较小且可能需要数年时间。进展似乎也很微小。持续的医学治疗可能会降低狭窄复发率，并可能随着时间的推移改善狭窄直径。
