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PATIENT CHARACTERISTICS, CLINICAL FEATURES, ENDOSCOPIC FINDINGS, AND RESPONSE TO TREATMENT OF PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
P Kazemi, W Chung, RA Enns, J Telford
Department of Medicine, University of British Columbia
INTRODUCTION: Eosinophilic esophagitis (EE) is an uncommon inflammatory condition of the esophagus that is being increasingly diagnosed in adults. Most patients present with dysphagia and food impaction, and many have associated allergic and/or atopic conditions. There is little existing literature on EE, and more studies are needed to fully characterize this condition and assess the efficacy of current treatments.
OBJECTIVE: To analyze demographics, symptoms, endoscopic findings, and response to treatment in a cohort of patients with EE.
METHODS: This is a retrospective study of patients diagnosed with EE at St. Paul’s Hospital in Vancouver. Esophageal biopsy results from 2005-07 were reviewed, and patients whose biopsies showed >20 eosinophils/high power field were included. Electronic chart review and telephone interview were conducted to assess patient demographics, endoscopic findings, and response to therapy. Chi-square test was used to assess for a relationship between patient characteristics and response to treatment.
Summary of RESULTS: Forty-three patients were identified (74% male) with mean age 44 years (SD 14 yr) The mean duration of symptoms was 7 years. All patients had solid food dysphagia with 34 (79%) a history of esophageal food impaction. Of those with an available history, 23 of 30 (77%) had associated allergies and/or atopy. A ringed esophagus was the most common endoscopic finding observed in 29 (67%) patients, while 6 (14%) patients had a normal esophagus endoscopically. Topical steroids (fluticasone) was used in 20 patients, and 15 (75%) reported clinical improvement. There was no significant association between duration of symptoms, history of impaction, the presence of endoscopic findings or a history of allergy/atopy and response to fluticasone. Symptoms recurred in 4 of the 15 patients upon fluticasone discontinuation. Thirteen patients underwent endoscopic dilation and all experienced clinical improvement with no complications. However, symptoms recurred in all patients dilated.