Eosinophilic esophagitis natural history

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Overview

Natural History

  • The natural course of primary eosinophilic esophagitis is as follows:[1]
  • 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.

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References

  1. Empty citation (help)
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.


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