Associate Editor Jenifer Lightdale, MD, MPH, reports on this month’s Editor’s Choice: an Original Article titled “A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease” by Evan S. Dellon, MD, MPH, Hannah P. Kim, MD, Sarah L. W. Sperry, MD, David A. Rybnicek, MD, John T. Woosley, MD, PhD, and Nicholas J. Shaheen, MD, MPH.
This study lends evidence to an increasingly plausible view of the natural history of eosinophilic esophagitis (EoE) over time. As a pediatric endoscopist, I often feel as though the patients I see with EoE are fundamentally different from adults who receive the same diagnosis. The results of this study support the theory that esophageal fibrosis associated with EoE may progress over time. Of course, this reality only raises the ante on myself and all other pediatric gastroenterologists to accurately identify and effectively treat EoE in our patients, so that they don’t show up in emergency rooms down the line with food impactions!
Patients with inflammatory phenotypes of eosinophilic esophagitis are younger and more likely to present with abdominal pain, nausea, and poor weight gain, while patients with fibrostenotic phenotypes are more likely to present with dysphagia and food impaction. Common esophageal findings of the 2 phenotypes are different, but both are characterized by a highly active eosinophilic infiltrate. The results of this study support the hypothesis that complications of EoE are the result of chronic inflammation leading to disease progression over time.
Figure 1. Predicted probability of developing a fibrostenotic phenotype of eosinophilic esophagitis based on age. CI, confidence interval.
Read the article abstract online here.
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