E0194 - Long-Term Follow-Up of Esophageal Strictures in Eosinophilic Esophagitis Using Structured Esophagram Protocol

Diana Snyder, MD¹, Jeff Alexander, MD¹, Karthik Ravi, MD², Jeff Fidler, MD¹, David A. Katzka, MD^3
1Mayo Clinic Rochester, Rochester, MN; ²Mayo Clinic, Rochester, MN; ³Columbia University, New York, NY

Introduction: Reversal of transmural fibrostenosis in eosinophilic esophagitis (EoE) is not well studied. Our aim was to determine the effect of medical therapy, dilation and initial diameter on esophageal lumen diameter using serial structured esophagrams over a period of years.

Methods: Retrospective study of 78 patients who completed two EoE protocol esophagrams at an academic tertiary referral center 2003 to 2021. Maximum and minimum esophageal diameters were measured on images during rapid swallowing in the RAO recumbent position. EoE was diagnosed by consensus definition and classified as active using ≥15 eosinophils per high power field (hpf). Demographics, medical therapies, and endoscopic data were obtained by chart review. Change in esophageal diameter was analyzed with Wilcoxon signed rank test and reported as median, 25^th percentile (Q1), and 75^th percentile (Q3) values.

Results: Median age at first esophagram was 36.2 and 60.3% were male. Medical therapies during last esophagram were PPI (39.5%), swallowed topical steroids (31.6%), diet elimination (13.2%), biologic therapies (1.3%), and clinical trials (1.3%). Eleven patients had dilation before the first esophagram and 33 between esophagrams without significant effect on results. Median years between esophagrams was 2.6 (Table 1). Median maximum diameter significantly increased by 1.0 mm (Q1: -1.0 mm, Q3: 3.0 mm) (P=0.034) independent of dilation (P=0.744). Median maximum diameter change per year significantly increased by 0.4 mm (Q1: -0.4 mm, Q3: 1.3 mm, P=0.010). The increase appeared most profound in patients starting in the lowest maximum diameter group (9-15 mm) with median increase of 3.0 mm while the highest starting maximum diameter group ( >21 mm) had further narrowing by 2.0 mm (Figure 1). There was no difference in maximum diameter change for patients on medical therapy compared to no therapy at second esophagram at 1.0 mm (Q1: -1.0 mm Q3: 3.0 mm) and 1.0 mm (Q1: 0.0 mm Q3: 2.0 mm) respectively (P=0.640); however, for patients in disease remission at second esophagram, there was a significant increase in maximum diameter per year compared to active disease at 0.8 mm (Q1: 0.0 mm Q3: 5.3 mm) and 0.0 mm (Q1: -0.4 mm Q3: 0.6 mm) respectively (P=0.019).

Discussion: Long term medical therapy leads to a small, but significant improvement in esophageal diameter in EoE. Whether this improvement is due to reversal of fibrosis or transmural inflammation is unclear.




Disclosures:


Diana Snyder, MD¹, Jeff Alexander, MD¹, Karthik Ravi, MD², Jeff Fidler, MD¹, David A. Katzka, MD³. E0194 - Long-Term Follow-Up of Esophageal Strictures in Eosinophilic Esophagitis Using Structured Esophagram Protocol, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.