Beveridge Claire A, Hermanns Christina, Thanawala Shivani, Yang Qijun, Qin Yi, Thota Prashanthi N, Hoscheit Matthew, Brown J Mark, Ivanov Andrei I, Lembo Anthony, Gabbard Scott, Rieder Florian
Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Digestive Diseases Institute, Cleveland, OH, USA.
Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, 2049 E. 100th Street, Crile, A Building, 3rd floor, Cleveland, OH, 44195, USA.
Dig Dis Sci. 2025 May;70(5):1824-1831. doi: 10.1007/s10620-025-08874-7. Epub 2025 Mar 1.
Eosinophilic Esophagitis (EoE) is a chronic inflammatory esophageal disorder, often complicated by strictures requiring dilation. There is limited information on the target esophageal luminal diameter (ELD) post-treatment to relieve symptoms. The aim of this study was to determine the ELD threshold associated with dysphagia resolution in EoE patients in histologic remission.
We performed a retrospective cohort study of adult EoE patients with a stricture in histologic remission. Patients were excluded if symptoms, EoE endoscopic reference score (EREFS), and ELD were missing. ELD was estimated by dilator diameter, endoscope passage, or functional lumen imaging probe. Symptoms, demographics, EREFS, and histology were recorded. Univariate and multivariable logistic regression analyses were performed. The ELD threshold for dysphagia was determined using receiver operating characteristics analyses.
Of the 76 patients who met criteria, 63 (82.9%) reported dysphagia. For every one-millimeter decrease in ELD, there was an increased odds of having dysphagia (OR 9.12, 95% CI 33.4, p < 0.001). The threshold ELD for having dysphagia was less than 16 mm (sensitivity: 96.8%, specificity: 92.3%). In a subcohort analysis of patients who were dilated (n = 58, 76.3%), the main predictor for persistent dysphagia post-dilation was the pre-dilation ELD (aOR 0.77, 95% CI 0.65-0.87, p < 0.001).
A decrease in ELD is associated with a higher odds of dysphagia in EoE patients in histologic remission. ELD of 16 mm or greater provided the strongest threshold for which symptoms were absent. This may present a reasonable dilation target.
嗜酸性粒细胞性食管炎（EoE）是一种慢性炎症性食管疾病，常并发狭窄，需要进行扩张治疗。关于治疗后缓解症状的目标食管腔直径（ELD）的信息有限。本研究的目的是确定组织学缓解的EoE患者中与吞咽困难缓解相关的ELD阈值。
我们对组织学缓解且有狭窄的成年EoE患者进行了一项回顾性队列研究。如果患者的症状、EoE内镜参考评分（EREFS）和ELD数据缺失，则将其排除。通过扩张器直径、内镜通过情况或功能性管腔成像探头估计ELD。记录症状、人口统计学数据、EREFS和组织学情况。进行单变量和多变量逻辑回归分析。使用受试者工作特征分析确定吞咽困难的ELD阈值。
在符合标准的76例患者中，63例（82.9%）报告有吞咽困难。ELD每减少1毫米，出现吞咽困难的几率就增加（比值比9.12，95%置信区间33.4，p < 0.001）。出现吞咽困难的阈值ELD小于16毫米（敏感性：96.8%，特异性：92.3%）。在对接受扩张治疗的患者亚组分析中（n = 58，76.3%），扩张后持续吞咽困难的主要预测因素是扩张前的ELD（校正比值比0.77，95%置信区间0.65 - 0.87，p < 0.001）。
在组织学缓解的EoE患者中，ELD降低与吞咽困难几率增加相关。16毫米或更大的ELD提供了无症状的最强阈值。这可能是一个合理的扩张目标。
