Visaggi Pierfrancesco, Del Corso Giulio, Solinas Irene, Ovidi Filippo, Adamo Giulia, Dulmin Isabella, Baiano Svizzero Federica, Bellini Massimo, Savarino Edoardo V, de Bortoli Nicola
Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Institute of Information Science and Technologies "A. Faedo", National Research Council of Italy (CNR), Pisa, Italy.
Am J Gastroenterol. 2024 Dec 30;120(8):1750-1759. doi: 10.14309/ajg.0000000000003272.
Adaptive behaviors at mealtime, esophageal symptom-specific anxiety and hypervigilance may affect dysphagia reporting in patients with eosinophilic esophagitis (EoE), but this has not been investigated. Moreover, the relationship between such confounding factors and histological disease activity (HDA) is unclear.
This was a prospective study on adults with EoE. Dysphagia, anxiety, and hypervigilance were assessed using specific questionnaires (i.e., modified dysphagia symptom questionnaire [mDSQ], Dysphagia Symptom Score [DSS], and Esophageal Hypervigilance and Anxiety Scale). Adaptive behaviors were assessed using the Pisa EoE Adaptation Questionnaire. Appropriate statistics was used to investigate correlation between dysphagia, anxiety, hypervigilance, adaptive behaviors, and HDA.
Ninety-five patients were included. Esophageal anxiety, hypervigilance, and use of adaptive behaviors were found in about 50% of patients with EoE. Esophageal anxiety and hypervigilance were significantly higher ( P = 0.03 for both), and adaptive behaviors were significantly more prevalent in histologically active EoE compared with EoE in remission (76.8% vs 25.6%, P < 0.001). As a standalone measurement, mDSQ and DSS had area under the receiver operating characteristic curve of 77.7% and 75.3% for predicting HDA. Adjustments of mDSQ and DSS based on individual Esophageal Hypervigilance and Anxiety Scale scores and adaptive behaviors at mealtime significantly improved the area under the receiver operating characteristic curve of mDSQ and DSS to 86.6% and 84.3%, respectively ( P < 0.05 for both).
Use of adaptive behaviors, higher esophageal anxiety and hypervigilance are associated with active EoE and represent clinical markers of HDA. Adaptive behaviors provide complementary clinical information that is not detected by symptoms alone. The assessment of adaptive behaviors, anxiety, and hypervigilance improves the correlation between clinical and HDA in EoE.
嗜酸性粒细胞性食管炎（EoE）患者用餐时的适应性行为、食管症状特异性焦虑和过度警觉可能会影响吞咽困难的报告，但尚未对此进行研究。此外，这些混杂因素与组织学疾病活动度（HDA）之间的关系尚不清楚。
这是一项针对成年EoE患者的前瞻性研究。使用特定问卷（即改良吞咽困难症状问卷[mDSQ]、吞咽困难症状评分[DSS]和食管过度警觉与焦虑量表）评估吞咽困难、焦虑和过度警觉。使用比萨EoE适应问卷评估适应性行为。采用适当的统计学方法研究吞咽困难、焦虑、过度警觉、适应性行为与HDA之间的相关性。
纳入95例患者。约50%的EoE患者存在食管焦虑、过度警觉和适应性行为。与缓解期的EoE相比，组织学活动期的EoE患者食管焦虑和过度警觉显著更高（两者P值均为0.03），适应性行为显著更常见（76.8%对25.6%，P<0.001）。作为一项独立测量指标，mDSQ和DSS预测HDA的受试者操作特征曲线下面积分别为77.7%和75.3%。根据个体食管过度警觉与焦虑量表评分和用餐时的适应性行为对mDSQ和DSS进行调整后，显著提高了mDSQ和DSS的受试者操作特征曲线下面积，分别达到86.6%和84.3%（两者P值均<0.05）。
适应性行为的使用、较高的食管焦虑和过度警觉与活动期EoE相关，是HDA的临床标志物。适应性行为提供了仅靠症状无法检测到的补充临床信息。对适应性行为、焦虑和过度警觉的评估改善了EoE临床与HDA之间的相关性。
