McCallen Justin D, Dave Mili, LaFata Sean S, Cameron Brenderia A, Xue Angela Z, Kiran Akshatha, Ocampo Adolfo A, Lee Christopher J, Borinsky Stephanie A, Redd Walker D, Cotton Cary C, Eluri Swathi, Reed Craig C, Dellon Evan S
Center for Esophageal Diseases and Swallowing.
Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
J Clin Gastroenterol. 2024 Oct 7. doi: 10.1097/MCG.0000000000002081.
To determine long-term efficacy and safety of tCS for treatment of EoE.
Maintenance therapy with topical corticosteroids (tCS) is recommended for eosinophilic esophagitis (EoE), but data for long-term use are still needed.
This retrospective cohort study assessed newly diagnosed patients with EoE who were treated with a tCS and had a follow-up endoscopy with biopsy after at least 5 years. Histologic symptomatic and endoscopic responses were extracted from medical records. Patients who did and did not have long-term tCS treatment were compared at baseline, and outcomes for patients were assessed at their last endoscopy while on tCS.
Of 431 patients with EoE treated with tCS, 104 met inclusion criteria for long-term use. For patients with long-term tCS use, the median time (IQR) on tCS was 6.5 years (5.4 to 8.8 y). At the last endoscopy, 54% had histologic response (<15 eos/hpf), but those with excellent adherence had a histologic response of 64%. Endoscopic severity also decreased with improved adherence which was strongly associated with EREFS (1.7 vs. 2.8 vs. 4.0 for excellent, good, and poor adherence; P<0.001). Symptomatic response was 68% overall, but only 40% in those with poor adherence (P=0.07). Complications of taking tCS were uncommon (adrenal insufficiency: 1%; osteopenia: 1%; and esophageal candidiasis: 4% at final endoscopy).
Long-term tCS (median 6.5 y) were generally effective, especially with better adherence, and also safe, with only rare serious complications. These data can be used to help patients make clinical decisions about chronic tCS use in EoE.
确定经皮迷走神经刺激（tCS）治疗嗜酸性粒细胞性食管炎（EoE）的长期疗效和安全性。
对于嗜酸性粒细胞性食管炎（EoE），推荐使用局部皮质类固醇（tCS）进行维持治疗，但仍需要长期使用的数据。
这项回顾性队列研究评估了新诊断的EoE患者，这些患者接受了tCS治疗，并在至少5年后进行了随访内镜检查及活检。从医疗记录中提取组织学症状和内镜反应。将接受和未接受长期tCS治疗的患者在基线时进行比较，并在患者接受tCS治疗的最后一次内镜检查时评估其结局。
在431例接受tCS治疗的EoE患者中，104例符合长期使用的纳入标准。对于长期使用tCS的患者，tCS的中位使用时间（四分位间距）为6.5年（5.4至8.8年）。在最后一次内镜检查时，54%的患者有组织学反应（<15个嗜酸性粒细胞/高倍视野），但依从性良好的患者组织学反应率为64%。内镜严重程度也随着依从性的改善而降低，这与食管内镜参考评分（EREFS）密切相关（依从性优秀、良好和差的患者分别为1.7、2.8和4.0；P<0.001）。总体症状缓解率为68%，但依从性差的患者中只有40%（P=0.07）。服用tCS的并发症并不常见（肾上腺功能不全：1%；骨质减少：1%；最后一次内镜检查时食管念珠菌病：4%）。
长期使用tCS（中位时间6.5年）总体上是有效的，尤其是依从性更好时，并且也是安全的，只有罕见的严重并发症。这些数据可用于帮助患者就EoE中慢性tCS的使用做出临床决策。
