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

Abstract

BACKGROUND & AIMS: Patient symptom reporting often does not correlate with the pathophysiological markers of esophageal disease, including eosinophilic esophagitis (EoE). Esophageal hypervigilance and symptom-specific anxiety are emerging as important considerations in understanding symptom reporting. As such, we aimed to conduct the first study of these constructs in EoE. METHODS: A retrospective review of an EoE patient registry was conducted and included eosinophils per high power field (from esophagogastroduodenoscopy biopsy: proximal, distal), endoscopic reference score, distal distensibility plateau (functional luminal imaging probe), Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, Northwestern Esophageal Quality of Life scale, and the Esophageal Hypervigilance and Anxiety Scale. Correlational and regression analyses evaluated relationships of hypervigilance and anxiety with Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, and Northwestern Esophageal Quality of Life scale when controlling for histology and endoscopic severity. RESULTS: One hundred and three patients had complete data, 69.9% were male, and the mean (SD) age was 40.66 (13.85) years. Forty-one percent had elevated dysphagia and 46% had elevated hypervigilance and anxiety. Esophageal symptom-specific anxiety emerged as the most important predictor of Brief Esophageal Dysphagia Questionnaire severity (44.8% of the variance), Visual Dysphagia Question of EoE Activity Index severity (26%), and poor health-related quality of life (HRQoL) (55.3%). Hypervigilance was also important, but to a lesser extent. Pathophysiological variables did not significantly predict symptoms or HRQoL. Recent food impaction can predict symptom-specific anxiety and proton pump inhibitor use can reduce hypervigilance. CONCLUSIONS: Hypervigilance and symptom-specific anxiety are important for our understanding of self-reported patient outcomes in EoE. These processes outweigh endoscopic and histologic markers of EoE disease activity across dysphagia, difficulty eating, and HRQoL. Clinicians should assess hypervigilance and anxiety, especially in patients with refractory symptoms and poor HRQoL.

General Well-being and Coping Strategies in Adult Eosinophilic Esophagitis Patients

“…Taken together, particularly (young) males that are diagnosed with EoE may be more at risk of impaired HRQOL, specifically related to food impaction. In addition to this, a recent study by Taft et al 45 observed that many EoE patients have elevated hypervigilance (ie, heightened focus on physical symptoms) and symptom specific anxiety such as swallowing anxiety, both being associated with worst reported EoE symptoms and poor HRQOL. These observations in mental health research emphasizes the importance of understanding the psychosocial issues being faced by EoE patients in clinical practice.…”

Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference

“…Fundamental limitations to the reliance on symptoms and histology for disease management are mitigated by incorporating a measure of endoscopic activity. 58,59 In children, symptoms can be nonspecific and include poor intake as well as avoidant restrictive food intake disorders, which may lead to an underappreciation of dysphagia. In adults, reports of dysphagia severity can also be affected by patient anxiety and hypervigilance and diminished by modifications to eating behaviors.…”

Refractory eosinophilic esophagitis: what to do when the patient has not responded to proton pump inhibitors, steroids and diet

“…Furthermore, it is well known that improvement in symptoms does not necessarily correlate with endoscopic or histologic measures of disease activity, especially in patients with fibrostenotic disease [14,15]. Finally, oesophageal hypervigilance and symptom-specific anxiety may contribute to patient-reported symptoms [16 ▪ ].…”