"Reducing Eosinophil Counts in Eosinophilic Esophagitis in Children Is Associated with Reduction in Later Stricture Development".

Abstract

OBJECTIVES There is limited longitudinal data on the impact of chronic therapy on the natural history of eosinophilic esophagitis [EoE], a chronic allergic disease of the esophagus. The purpose of this study was to evaluate if patients with well-controlled EoE were less likely to develop fibrostenotic complications. METHODS Subjects were identified from a database of pediatric EoE patients at the Children's Hospital of Philadelphia started in 2000. Patients were then searched in adult medical records to identify patients who transitioned care. All office visits, emergency department (ED) visits and endoscopic, histologic, and imaging reports were reviewed for the primary outcome of strictures and the secondary outcomes of food impactions and dysphagia. Cox proportional hazard regression was performed for outcomes. RESULTS 105 patients were identified with mean follow up of 11.4 + 4.9 years. 52.3% (n=55) had a period of histologic disease control defined as > 2 consecutive endoscopies with histologic remission. These patients were less likely to develop strictures compared to patients who did not have a period of histologic control (HR 0.232; 95% CI 0.084-0.64, p=0.005). Patients who were diagnosed at younger ages were less likely to develop strictures. Presentation with dysphagia or impaction was associated with higher rate of stricture development. CONCLUSIONS In this cohort study with > 10 years of follow up, children with EoE with a period of histologic disease control and diagnosed at younger ages were less likely to develop esophageal strictures. While this suggests histologic remission is associated with reduction of remodeling complications, additional prospective data with long-term follow up is needed.