P0295 - The Impact of Obesity on Fibrostenosis Progression of Eosinophilic Esophagitis in a U.S. Veterans Cohort

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

TT

Tyler Tsang, BA

Albany Medical College
Albany, NY, United States

Tyler Tsang, BA¹, Alexa Trovato, BA¹, Nihita Manem, BS¹, Katherine Donovan, BS¹, Darren E. Gemoets, PhD², Christopher Ashley, MD, MPH, FACG², Evan S. Dellon, MD, MPH, FACG³, Micheal Tadros, MD, MPH, FACG¹
¹Albany Medical College, Albany, NY; ²Stratton Veteran Affairs Medical Center, Albany, NY; ³University of North Carolina School of Medicine, Chapel Hill, NC

Introduction: Our pilot work suggests that obesity may be protective against progression to fibrostenosis of EoE. The aim of this study was to assess the extent to which obesity impacts the progression of EoE and if BMI is correlated with reduced disease severity.

Methods: A retrospective analysis of patient data from the Department of Veterans Affairs EHR system was done. Patients with EoE who received at least one dilation were identified and analyzed using ICD and CPT codes. Kaplan-Meier curves were used to assess BMI and time to second esophageal dilation as a measurement of severity of disease. Cox proportional hazards models were used to determine the risk of second dilation adjusted for the variables studied.

Results: Out of the 2890 patients with EoE, 40% were obese. There was no clinically significant difference in terms of gender, mean age of diagnosis, or race between obese and non-obese patients. Non-obese patients were more likely to be smokers, malnourished, and had a higher mean average of the number of dilation visits compared to obese patients (Table 1, p < 0.05). Obese patients were more likely to have chest pain compared to non-obese patients with EoE (p < 0.05), whereas heartburn, food impaction, and the presence of a hiatal hernia were not statistically significant between both groups. When stratified by obese (n=1165) and non-obese (n=1725), non-obese individuals had a median time to next dilation of 6.53 years (95% CI: 5.83,7.79) compared to 9.24 years for obese individuals (95% CI: 7.40, 15.04) (Figure 1A). When stratified by the six BMI categories, the median time to second dilation increased with increasing BMI (Figure 1B). The hazard ratio of second dilation for obese individuals was 0.81 (95% CI: 0.72-0.92) (Figure 1C). Aside from a minimally increased hazard ratio seen in smokers, there was no significant effect on second dilation rate attributable to any of the other variables studied.

Discussion: This study supports our pilot work that obesity may have a protective role in EoE related to fibrostenosis. Patients with a higher BMI are less likely to undergo a second dilation as compared to those with a lower BMI, and this association holds in dose-response fashion by degree of obesity. Further research should assess potential mechanisms, as well as whether severe strictures in EoE patients may lead to malnourishment and an intractable disease course.

Figure: Figure 1. Kapan Meier curve delineating the median time to second esophageal dilation. A. Stratification by obese and non-obese BMIs shows that obese individuals had a longer time before undergoing a second esophageal dilation. B. Stratification of BMI into 6 groups for dose-response analysis showing that time to second dilation increases with increasing BMI. C. Cox proportional hazard model with second esophageal dilation as the response. BMI, age at EGD diagnosis, race, smoking status and steroid use act as predictors/covariates.

	BMI > 30	BMI < 30	p value
Male	89.50%	92.60%	0.0052
Mean Age (years)	46.9	47.7	< 0.0001
Caucasian	81.40%	84.10%	0.017
African American	10.30%	7.30%	0.017
Smoker	30.70%	36.23%	0.0025
Malnutrition	1.12%	3.07%	0.00088
Chest Pain	41.00%	34.43%	0.00037
Heart Burn	9.53%	9.10%	0.75
Food Impaction	9.79%	10.49%	0.58
Hiatal Hernia	42.20%	42.20%	1
Steroid Use	2.66%	1.97%	0.27
Number of Dilation Visits	1.94	2.35	0.0002
Mean Number ED Visits	2.13	2.07	0.66
Mean Number new office visits	5.35	5.06	0.087
Mean number return office visits	52.98	51.11	0.288

Table: Table 1. Demographic variables, symptomatology, and number of ED and office visits in obese and non-obese individuals.

Disclosures:

Tyler Tsang indicated no relevant financial relationships.

Alexa Trovato indicated no relevant financial relationships.

Nihita Manem indicated no relevant financial relationships.

Katherine Donovan indicated no relevant financial relationships.

Darren E. Gemoets indicated no relevant financial relationships.

Christopher Ashley indicated no relevant financial relationships.

Evan Dellon indicated no relevant financial relationships.

Micheal Tadros indicated no relevant financial relationships.

Tyler Tsang, BA¹, Alexa Trovato, BA¹, Nihita Manem, BS¹, Katherine Donovan, BS¹, Darren E. Gemoets, PhD², Christopher Ashley, MD, MPH, FACG², Evan S. Dellon, MD, MPH, FACG³, Micheal Tadros, MD, MPH, FACG¹. P0295 - The Impact of Obesity on Fibrostenosis Progression of Eosinophilic Esophagitis in a U.S. Veterans Cohort, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.