Assessing the Risk Factors for Refractory Eosinophilic Esophagitis in Children and Adults

Abstract

Background Up to one-third of the patients suffering from eosinophilic esophagitis (EoE) present a refractory form, as defined by nonresponsiveness in clinical, endoscopic, or histological assessment after first-line therapy. Several studies recently investigated which factors can influence the development of this disease, but very few analyzed the factors underlying refractory EoE. Methods Medical charts of patients affected by EoE were retrospectively evaluated. Phenotyping of patients was conducted according to demographic, clinical, histological, and treatment variables. Then, patients were divided into responder and nonresponder to therapy and distinguished among children and adults. Results Forty-five children and 35 adult EoE patients were included. In the pediatric population, female sex (p < 0.05) and a higher score of visual analogue scale (VAS) at the follow-up visit (p = 0.02) were significantly associated to the risk of refractory EoE. Among adults, statistical significance was reached for years of follow-up (p = 0.001), diagnostic delay (p = 0.03), use of antibiotics during infancy (p = 0.01), and food allergy (p = 0.04). Conclusions Our study highlighted female sex and a higher VAS score at the time of follow-up visits as risk factors for refractory EoE in children, while the risk factors in adults were identified as fewer years of follow-up, greater diagnostic delay, use of antibiotics during infancy, and food allergy.

Immunogenetic, Molecular and Microbiotic Determinants of Eosinophilic Esophagitis and Clinical Practice—A New Perspective of an Old Disease

“…On the other hand, IgE-mediated food allergies (especially for peanuts and tree nuts) were observed more frequently among children with EoE. At this point, it is essential to highlight that although non-IgE-mediated food allergy is well established among the pathogenesis of EoE—also in adults—it should be remembered that not all allergens can increase the risk in the same way or the same proportion [ 28 ]. It should be also further investigated how and if the presence of IgE-mediated food allergy influences the diagnosis or the course of the disease [ 1 , 10 , 29 ].…”

An Update on Eosinophilic Esophagitis: Etiological Factors, Coexisting Diseases, and Complications

“…The pathogenesis of EoE is relatively poorly understood. Increasing evidence suggests a strong involvement of genetic and environmental factors [26], premature delivery, cesarean birth, early antibiotic exposure, food allergy, lack of breast feeding, and lack of early microbial exposure are associated with EoE [7, 11] (Table 1).…”

“…EoE is still a relatively poorly understood entity. Increasing evidence indicates a vigorous presence of the involvement of genetic and environmental factors [26]. The T helper type 2 (TH2)-mediated inflammatory cytokines, interleukin (IL)-4, IL-5, IL-13 [1, 3, 11, 15, 16, 44, 45], and IL-33 in pediatric [46], and invariant natural killer T cells [26] are involved in trafficking eosinophils into esophageal tissue.…”

“…The majority of patients with EoE are atopic [2, 26, 44]. Most studies reported associations between EoE and atopic disorders.…”

“…EoE may contribute to the development of GERD via many eosinophil products that can relax the muscle of the lower esophageal sphincter as a result altering motility or causing structural changes. In contrast, GERD causes EoE, leading to acid injury of the epithelium, increased epithelial permeability, and increased immune cells recruitment [26, 67, 82].…”