Cohort Profile: The Swiss Eosinophilic Esophagitis Cohort Study (SEECS)

Abstract

Background and Aims: The prospective, observational Swiss Eosinophilic Esophagitis Cohort Study (SEECS) was set up in 2015 with the following goals in mind: (1) to provide up-to-date epidemiologic data; (2) to assess the appropriateness of care; (3) to evaluate the psychosocial impact; and (4) to foster translational research projects. Data capture relies on validated instruments to assess disease activity and focuses on epidemiologic variables and biosamples (esophageal biopsies and blood specimens). An annual inclusion of 70 new patients with eosinophilic esophagitis (EoE) or proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is intended. We herein describe the SEECS cohort profile. Methods: The SEECS includes adult patients (age ≥18 years) with EoE or PPI-REE diagnosed according to published criteria. After inclusion, the patients are typically seen once a year for a clinical and endoscopic/histologic follow-up examination. Data are captured using validated questionnaires. Biosamples from patients with gastroesophageal reflux disease (GERD) and controls with a healthy esophagus are collected as well. Results: From January 2016 to July 2017, a total of 111 patients with EoE and 10 patients with PPI-REE were recruited. In addition, esophageal biopsies and blood samples from 11 patients with GERD and 20 controls with a healthy esophagus were collected. The mean age of the patients with EoE and those with PPI-REE was 39.6 ± 12.9 and 44.6 ± 15.6 years, respectively. A male predominance was found among both the patients with EoE (77.5%) and those with PPI-REE (70%). Concomitant allergic disorders were found in 79.3% of the patients with EoE and 90% of the patients with PPI-REE. At inclusion, the EoE patients were treated with the following therapeutic regimens: no therapy (0.9%), PPI (36%), swallowed topical corticosteroids (82.9%), elimination diets (15.3%), and esophageal dilation (19.8%). Conclusions: The SEECS is the first national cohort study of patients with EoE or PPI-REE. The SEECS will provide up-to-date epidemiologic data and foster translational research projects.

Esophageal Hypervigilance and Symptom-Specific Anxiety in Patients with Eosinophilic Esophagitis

“…In prior studies evaluating diseasespecific quality of life, anxiety related to choking episodes was consistently associated with greater dysphagia severity in both English-and Spanish-speaking patients. 11,[27][28][29][30][31] Specifically, patients reporting higher scores on the EEsAI-VDQ had poorer disease-specific HRQoL, 12 as measured by the Adult Eosinophilic Esophagitis Quality of Life (EoE-QOL-A), 30 explaining 31% of the variance in choking and illnessrelated anxiety. This, combined with our findings that experiencing a food impaction in the past 2 weeks may result in more anxiety, suggests prior food impactions that patients found particularly painful or distressing can contribute to heightened fears about food getting stuck again.…”

Eosinophilic esophagitis: latest insights from diagnosis to therapy

“…Among nonresponders to PPI who suffer from symptoms related to inflammatory activity, most patients will choose a therapy with STCs and only about 20% of patients will be willing to undergo a food elimination diet. 67 This is related to the fact that the use of STCs is better compatible with the daily lifestyle than food elimination diets which require motivated and disciplined patients. As of yet, there exist no data about the satisfaction of EoE patients regarding different therapeutic options.…”

Technical feasibility, clinical effectiveness, and safety of esophageal stricture dilation using a novel endoscopic attachment cap in adults with eosinophilic esophagitis

“…For assessment of histologic activity at least 3 biopsy specimens were taken from each the proximal and distal esophagus. 13 The study was approved by the 6 ethical committees covering the German and French speaking part of Switzerland (CER-VD 148/15). To be J o u r n a l P r e -p r o o f eligible for BougieCap dilation, EoE patients included into SEECS had to fulfill the following criteria: (1) clinically active EoE, defined as EEsAI PRO ≥20 points; (2) esophageal diameter ≤14 mm (esophageal caliber was measured using BougieCap).…”