Eosinophilic esophagitis natural history
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Overview
In patients with EoE, symptoms persist over years raising suspicion that a chronic inflammatory process is an underlying event responsible for it. The inflammatory activity is proportional to the density of the eosinophilic infiltration in the esophageal tissue. Similar to asthma, EoE has chronic persistent eosinophilic inflammation and can eventually lead to irreversible structural changes of the esophagus which is called re-modeling of the esophagus. The esophageal mucosa in patients with a longstanding EoE is characterized by a loss of elasticity. On histologic examination of the subepithelial compartments of the esophagus show an increase in the fibrous tissue. The endosonographic studies of the esophagus in patients with EoE shows following findings: Thickening of the mucosa, Thickening of the submucosal, and muscularis propria layers. In patients with EoE, the chronic eosinophilic inflammation leads to an increased deposition of the fibrous connective tissue which in turn causes the remodeling of the esophagus hindering the esophageal transport. The complications of the EoE are as follows Scarring of esophagus-leading to dysphagia, Esophageal stenosis- causing food stuck. Tears or perforation during the endoscopy or retching leading to boerhaave syndrome. The prognosis of the EoE is as follows: EoE is a relatively newly recognized disease, there is very limited data on the causes, natural history, prognosis, diagnosis and management of these patients. The long-term prognosis of the EoE is unclear but patients diagnosed with EoE have an unaffected lifespan. Patients should be counseled that although it is a chronic disease, it is a benign condition. Patients who are untreated or have discontinued the treatment have progression of their symptoms. The EoE patients with a narrow esophageal lumen are resistant to the corticosteroid treatment and require many esophageal endoscopic procedures. The dysphagia is common in patients with increased eosinophil count in the blood. The EoE is restricted only to the esophagus sparing the stomach and the duodenum. A common concern by patient and their families is what is the chance of that EoE may progress to a malignancy if untreated, EoE does not progress into metaplasia or dysplasia or esophageal cancer.
Natural History
- The natural course of primary EoE is as follows:[1][2][3]
- In patients with EoE, symptoms persist over years raising suspicion that a chronic inflammatory process is an underlying event responsible for it.
- The inflammatory activity is proportional to the density of the eosinophilic infiltration in the esophageal tissue.
- Similar to asthma, EoE has chronic persistent eosinophilic inflammation and can eventually lead to irreversible structural changes of the esophagus which is called re-modeling of the esophagus.
- The esophageal mucosa in patients with a longstanding EoE is characterized by a loss of elasticity.
- On histologic examination of the subepithelial compartments of the esophagus show an increase in the fibrous tissue.
- The endosonographic studies of the esophagus in patients with EoE shows following findings:
- Thickening of the mucosa
- Thickening of the submucosal, and muscularis propria layers
- In patients with EoE, the chronic eosinophilic inflammation leads to an increased deposition of the fibrous connective tissue which in turn causes the remodeling of the esophagus hindering the esophageal transport.
Complications
- The complications of the EoE are as follows:[4][5][6]
- Scarring of esophagus-leading to dysphagia
- Esophageal stenosis- causing food stuck
- Tears or perforation during the endoscopy or retching leading to boerhaave syndrome.
Prognosis
- The prognosis of the EoE is as follows:[7][8][9][10][11]
- EoE is a relatively newly recognized disease, there is very limited data on the causes, natural history, prognosis, diagnosis and management of these patients.
- The long-term prognosis of the EoE is unclear but patients diagnosed with EoE have an unaffected lifespan.
- Patients should be counseled that although it is a chronic disease, it is a benign condition.
- Patients who are untreated or have discontinued the treatment have progression of their symptoms.
- The EoE patients with a narrow esophageal lumen are resistant to the corticosteroid treatment and require many esophageal endoscopic procedures..
- The dysphagia is common in patients with increased eosinophil count in the blood.
- The EoE is restricted only to the esophagus sparing the stomach and the duodenum.
- A common concern by patient and their families is what is the chance of that EoE may progress to a malignancy if untreated, EoE does not progress into metaplasia or dysplasia or esophageal cancer.
References
- ↑ Attwood SE, Furuta GT (2014). "Eosinophilic esophagitis: historical perspective on an evolving disease". Gastroenterol. Clin. North Am. 43 (2): 185–99. doi:10.1016/j.gtc.2014.02.010. PMC 4035232. PMID 24813509.
- ↑ Dellon ES, Hirano I (2017). "Epidemiology and Natural History of Eosinophilic Esophagitis". Gastroenterology. doi:10.1053/j.gastro.2017.06.067. PMID 28774845.
- ↑ Falk GW (2014). "Clinical presentation of eosinophilic esophagitis in adults". Gastroenterol. Clin. North Am. 43 (2): 231–42. doi:10.1016/j.gtc.2014.02.009. PMID 24813512.
- ↑ Straumann A (2011). "The natural history and complications of eosinophilic esophagitis". Thorac Surg Clin. 21 (4): 575–87. doi:10.1016/j.thorsurg.2011.09.004. PMID 22040638.
- ↑ Chehade M, Lucendo AJ, Achem SR, Souza RF (2013). "Causes, evaluation, and consequences of eosinophilic esophagitis". Ann. N. Y. Acad. Sci. 1300: 110–8. doi:10.1111/nyas.12243. PMID 24117638.
- ↑ Saillen E, Cellier C, Naneix AL, Canioni D, Bruneval P, Pouchot J, Georgin-Lavialle S (2014). "[Eosinophilic esophagitis]". Presse Med (in French). 43 (1): 34–8. doi:10.1016/j.lpm.2013.03.012. PMID 23891531.
- ↑ Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA (2013). "ACG clinical guideline: Evidence-based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)". Am. J. Gastroenterol. 108 (5): 679–92, quiz 693. doi:10.1038/ajg.2013.71. PMID 23567357.
- ↑ Lipka S, Keshishian J, Boyce HW, Estores D, Richter JE (2014). "The natural history of steroid-naïve eosinophilic esophagitis in adults treated with endoscopic dilation and proton pump inhibitor therapy over a mean duration of nearly 14 years". Gastrointest. Endosc. 80 (4): 592–8. doi:10.1016/j.gie.2014.02.012. PMID 24703087.
- ↑ Eluri S, Runge TM, Cotton CC, Burk CM, Wolf WA, Woosley JT, Shaheen NJ, Dellon ES (2016). "The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis". Gastrointest. Endosc. 83 (6): 1142–8. doi:10.1016/j.gie.2015.11.019. PMID 26608127.
- ↑ Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU (2003). "Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years". Gastroenterology. 125 (6): 1660–9. PMID 14724818.
- ↑ Spergel JM, Brown-Whitehorn TF, Beausoleil JL, Franciosi J, Shuker M, Verma R, Liacouras CA (2009). "14 years of eosinophilic esophagitis: clinical features and prognosis". J. Pediatr. Gastroenterol. Nutr. 48 (1): 30–6. doi:10.1097/MPG.0b013e3181788282. PMID 19172120.