Original ResearchFull Report: Clinical—Alimentary TractDelay in Diagnosis of Eosinophilic Esophagitis Increases Risk for Stricture Formation in a Time-Dependent Manner
Section snippets
Swiss EoE Database
We performed a retrospective analysis of the Swiss EoE database (SEED) and an extensive review of all patient records. The SEED was founded in 1989 by the senior author (AS) and currently includes data on 783 EoE patients from all over Switzerland. The data are stored in the Swiss EoE Clinic located in Olten, Switzerland. Of 783 patients, 323 patients (41.3%) are followed up and treated on a regular basis at the Swiss EoE Clinic by the senior author. In order to minimize the limitations of the
Patient Characteristics
The flow chart of the study population is shown in Supplementary Figure 1. Of 783 patients included into SEED, 323 were diagnosed by the senior author according to standardized protocols for assessment of clinical, endoscopic, histologic, and laboratory disease activity. Data on 123 patients were excluded due to either incomplete or missing information (records of 41, 37, 26, and 19 patients were missing data on the endoscopic features of EoE, symptom severity, laboratory workup, and histology,
Discussion
Stricture formation is a major complication of EoE. We were able to demonstrate that patients are more likely to present with purely inflammatory endoscopic EoE features early in the disease course and then progress to develop fibrotic endoscopic features, in addition to inflammatory features. Also, the risk of developing esophageal strictures is significantly associated with the length of diagnostic delay, a time period from appearance of first symptoms to establishment of EoE diagnosis. We
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Author names in bold designate shared co-first authorship.
This article has an accompanying continuing medical education activity on page e13. Learning Objective: Upon completion of this CME section, successful learners will be able to: explain the typical clinical pattern of a patient with eosinophilic esophagitis, diagnose EoE, differentiate EoE from other conditions associated with esophageal eosinophilia, and identify the key factor associated with the generation of strictures in EoE.
Conflicts of interest The authors disclose no conflicts.
Funding This work was supported by a grant from the Swiss National Science Foundation (grant no. 32003B_135665/1) to AMS and AS.
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Authors share co-first authorship.