THE NATURAL HISTORY OF EOSINOPHILIC OESOPHAGITIS IN THE TRANSITION FROM CHILDHOOD TO ADULTHOOD

FCAAIA Notes: Eosinophilic esophagitis (EoE) is a comparatively newly diagnosed (or recognized) condition.  Sometimes, it is easy to suspect from typical clinical symptoms, but sometimes its clinical presentation is much more subtle. In all cases, the diagnosis must be confirmed by biopsy of the esophagus.

The question of the natural history of EoE frequently arises.  That is, does it get better on its own?  How fast?  How often?  The answer has usually been that we really don’t know.  We have experience, but that is not the same as data.  This study starts to answer the question.  It shows that a large proportion of children with EoE still had symptoms and/or required medications or dietary restriction in to adulthood.

So, the answer to the natural history of EoE?  We still don’t know, but are getting a better sense of how to answer.

(Source: http://www.medscape.com/viewarticle/776170?src=journalnl&uac=112079PK  February 14, 2013. Adapted from Aliment Pharmacol Ther. 2013;37(1):114-121). For Medscape articles: User name: FCAAIA, Password: Allergies

Background Eosinophilic oesophagitis (EoE) is a chronic inflammatory condition affecting both children and adults. Little is known about the natural history of EoE in the transition from childhood into adulthood.

Aim To determine the prevalence of EoE symptoms and impact of EoE on quality of life among adults diagnosed with EoE during childhood.

Methods This is a cross-sectional study of EoE patients from the Children’s Hospital of Philadelphia   EoE registry. Patients ≥18 years diagnosed with EoE during childhood were administered validated dysphagia [Mayo Dysphagia Questionnaire (MDQ)-30] and Quality of Life (PAGI-QOL) questionnaires. Ongoing EoE treatments were ascertained.

Results A total of 140 EoE patients ≥18 years were identified; 53 completed all questions. Only 6 (11%) subjects had positive (n = 2) or indeterminate (n = 4) dysphagia scores. However, of 47 patients with negative scores, 18 (37%) reported ongoing difficulty swallowing. The mean PAGI-QOL score was 4.58/5. The dietary dimension score was 3.73/5. Current pharmacological EoE treatments were topical steroids (3/53) and interleukin-5 antagonists (3/53). Additionally, 26/53 (49%) were on PPI therapy and 40/53 (76%) were following allergy directed diets.

Conclusions The majority of young adults diagnosed with EoE during childhood continue to require pharmacological treatment and/or dietary modification for EoE. A substantial proportion of this population experiences ongoing swallowing difficulties that a standard dysphagia questionnaire fails to capture. Dietary quality of life, but not total quality of life, appears to be adversely affected. These data suggest that EoE diagnosed during childhood remains a significant medical issue during early adulthood, and that better EoE symptom measurement instruments are needed.

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