Older patients with eosinophilic esophagitis have high treatment response to topical steroids

Ketchem, Corey J.; Thakkar, Kisan; Xue, Angela; Reddy, Sumana; Abramson, Lior; Greenberg, Sydney B.; Abichandani, Sonia; Miller, Talya L.; Chang, Nicole C.; Eluri, Swathi; Reed, Craig C.; Dellon, Evan S.

doi:10.1016/j.dld.2021.10.004

Cited by 9 publications

(11 citation statements)

References 43 publications

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“…Prediction of treatment response related to tCS is an area of active research. Nonresponse has been associated with esophageal dilation (42–44), severe esophageal narrowing (45), increased BMI (30), younger age (31,44), and molecular features (46,47). In our analysis, the lower response rate in non-Whites persisted despite adjusting for these other known factors related to tCS response.…”

Section: Discussionmentioning

confidence: 99%

“…At our center, tCS for EoE are prescribed per clinical protocol and can include either swallowed fluticasone (typically from an inhaler) or budesonide (mixed into a slurry from the aqueous formulation), with dosing dependent on patient age and size. The initial course is usually 2-3 months, and then, response is assessed on follow-up endoscopy and biopsy (30,31).…”

Section: Methodsmentioning

confidence: 99%

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Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

Ocampo,

Xue,

Chang

et al. 2023

Am J Gastroenterol

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Introduction: Differences in EoE presentation and outcomes by ethnicity or race remain understudied. We aimed to determine whether EoE patients of Hispanic/Latinx ethnicity or non-White race have differences in presentation at diagnosis or response to topical corticosteroid (tCS) treatment. Methods: This retrospective cohort study included subjects of any age with a new diagnosis of EoE and documentation of ethnicity or race. For those who had treatment with tCS and follow-up endoscopy/biopsy, we assessed histologic response (<15 eosinophils/hpf), global symptom response, and endoscopic responses. Hispanic EoE patients were compared to non-Hispanics at baseline, and before and after treatment. The same analyses were repeated for White vs non-Whites. Results: Of 1026 EoE patients with ethnicity data, just 23 (2%) were Hispanic. Most clinical features at presentation were similar to non-Hispanic EoE patients but histologic response to tCS was numerically lower (38% vs 57%). Non-White EoE patients (13%) were younger at diagnosis, had less insurance, lower zip code-level income, shorter symptom duration, more vomiting, less dysphagia and food impaction, fewer typical endoscopic features, and less dilation. Of 475 patients with race data treated with tCS, non-Whites had a significantly lower histologic response rate (41% vs 59%; p=0.01), and odds of histologic response remained lower after controlling for potential confounders (aOR 0.40, 95%CI: 0.19-0.87). Discussion: Few EoE patients at our center were Hispanic, and they had similar clinical presentations as non-Hispanics. The non-White EoE group was larger, and presentation was less dysphagia-specific. Non-White patients were also less than half as likely to respond to tCS.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

Ocampo,

Xue,

Chang

et al. 2023

Am J Gastroenterol

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“…We conducted a retrospective cohort study of the University of North Carolina (UNC) EoE Clinicopathologic database, which has been previously described [ 26 – 31 ]. In brief, this database includes data from newly diagnosed EoE cases of all ages based on consensus guidelines at the time of their diagnosis [ 2 , 4 , 32 , 33 ].…”

Section: Methodsmentioning

confidence: 99%

“…Because this was a retrospective study, we were not able to assess validated or prospectively obtained patient-reported outcomes. Instead, we extracted the global patient-reported symptom response, as indicated in the chart, which is a metric we have successfully used previously [ 28 , 31 , 42 ].…”

Section: Methodsmentioning

confidence: 99%

Worsened Fibrostenotic Outcomes in Eosinophilic Esophagitis Patients Due to COVID-19-Related Endoscopy Cancellations

Ocampo

Dellon

2022

Dig Dis Sci

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“…The difference in reported prevalence between non‐elderly and elderly EoE cohorts may derive from a generational cohort effect, which may in part be related to the ‘hygiene hypothesis’ 15 . This disparity may be further exacerbated by a milder phenotype in elderly EoE patients, attenuation of EoE symptoms with age, 16 decreased symptom reporting with age 17 and significant diagnostic delay among elderly patients with EoE 18 . As such, the condition has been taught to be most prevalent in children and adolescents, which may produce a bias to detection for elderly patients endorsing symptoms compatible with the condition 19 .…”

Section: Introductionmentioning

confidence: 99%

Retrospective cohort study: Effect of age as a barrier to diagnosis of eosinophilic oesophagitis

Kiran,

Dellon,

Reed

2023

Aliment Pharmacol Ther

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SummaryBackgroundPrior work suggests eosinophilic oesophagitis (EoE) is rare in those aged over 65 years. However, elderly patients with EoE experience a substantial diagnostic delay from symptom onset to diagnosis.AimsTo assess if age predicted whether oesophageal biopsies were obtained in patients with EoE symptoms, what clinical features predict EoE in the elderly, and if EoE phenotype differs between elderly and non‐elderly patients.MethodsWe conducted a retrospective cohort study utilising the University of North Carolina (UNC) electronic medical record, EoE clinicopathologic database and UNC endoscopy software from July 2008 to April 2021. A sample of 193 elderly and non‐elderly patients with dysphagia, chest pain and/or heartburn were assembled. Patients with EoE were newly diagnosed per contemporaneous guidelines. Patient demographics, clinical characteristics and procedural data were extracted. Summary statistics, bivariate and multivariate analyses were performed.ResultsOf 193 patients, we included 91 elderly (47%) and 102 non‐elderly (53%). Age independently predicted the odds of biopsies (adjusted odds ratio (aOR): 0.44 elderly vs. non‐elderly; 95% CI: 0.21–0.92). Endoscopic features of EoE, but not symptoms, were more common in elderly than non‐EoE elderly patients. Elderly patients with EoE differed from non‐elderly only by time to diagnosis (aOR per year of symptoms preceding diagnosis: 1.08, 95% CI: 1.04–1.11).ConclusionsElderly patients with EoE have <50% the odds of oesophageal biopsies. There were no significant differences between elderly and non‐elderly EoE patients, although endoscopic features helped discriminate the two groups. Our findings suggest that older age represents a barrier to EoE diagnosis.

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Older patients with eosinophilic esophagitis have high treatment response to topical steroids

Cited by 9 publications

References 43 publications

Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

Worsened Fibrostenotic Outcomes in Eosinophilic Esophagitis Patients Due to COVID-19-Related Endoscopy Cancellations

Retrospective cohort study: Effect of age as a barrier to diagnosis of eosinophilic oesophagitis

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