Swallowed topical corticosteroids reduce the risk for long‐lasting bolus impactions in eosinophilic esophagitis. Issue 9 (3rd July 2014)

• Record Type: Journal Article
• Authors: Kuchen, T.; Straumann, A.; Safroneeva, E.; Romero, Y.; Bussmann, C.; Vavricka, S.; Netzer, P.; Reinhard, A.; Portmann, S.; Schoepfer, A. M.
• Is Part Of: Allergy. Volume 69:Issue 9(2014:Sep.)
• Page Start: 1248
• Page End: 1254
• Publication Date: 2014-07-03
• Subjects: Allergy -- Periodicals; 616.97
• DOI: 10.1111/all.12455
• Languages: English
• ISSNs: 0105-4538

Abstract

<abstract abstract-type="main" id="all12455-abs-0001"> <title>Abstract</title> <sec id="all12455-sec-0001" sec-type="section"> <title>Background</title> <p>Long‐lasting food impactions requiring endoscopic bolus removal occur frequently in patients with eosinophilic esophagitis (EoE) and harbor a risk for severe esophageal injuries. We evaluated whether treatment with swallowed topical corticosteroids is able to reduce the risk of occurrence of this complication.</p> </sec> <sec id="all12455-sec-0002" sec-type="section"> <title>Methods</title> <p>We analyzed data from the Swiss EoE Cohort Study. Patients with yearly clinic visits, during which standardized assessment of symptoms, endoscopic, histologic, and laboratory findings was carried out, were included.</p> </sec> <sec id="all12455-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 206 patients (157 males) were analyzed. The median follow‐up time was 5 years with a total of 703 visits (mean 3.41 visits/patient). During the follow‐up period, 33 patients (16 % of the cohort) experienced 42 impactions requiring endoscopic bolus removal. We evaluated the following factors regarding the outcome 'bolus impaction' by univariate logistic regression modeling: swallowed topical corticosteroid therapy (OR 0.503, 95%‐CI 0.255–0.993, <italic>P </italic>=<italic> </italic>0.048), presence of EoE symptoms (OR 1.150, 95%‐CI 0.4668–2.835, <italic>P</italic> = 0.761), esophageal stricture (OR 2.832, 95%‐CI 1.508–5.321, <italic>P</italic> = 0.001), peak eosinophil count >10 eosinophils/HPF (OR 0.724, 95%‐CI 0.324–1.621, <italic>P</italic> = 0.433), blood eosinophilia (OR 1.532, 95%‐CI 0.569–4.118, <italic>P</italic> = 0.398), and esophageal dilation (OR 1.852, 95%‐CI 1.034–3.755, <italic>P</italic> = 0.017). In the multivariate model, the following factors were significantly associated with bolus impaction: swallowed topical corticosteroid therapy (OR 0.411, 95%‐CI 0.203–0.835, <italic>P</italic> = 0.014) and esophageal stricture (OR 2.666, 95%‐CI 1.259–5.645, <italic>P</italic> = 0.01). Increasing frequency of use of swallowed topical steroids was associated with a lower risk for bolus impactions.</p> </sec> <sec id="all12455-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Treatment of EoE with swallowed topical corticosteroids significantly reduces the risk for long‐lasting bolus impactions.</p> </sec> </abstract>