Researchers Advocate for Closer Monitoring of Patients With EoE

A study of adult patients with eosinophilic esophagitis in remission showed that those who were followed more closely in the maintenance phase of treatment had fewer strictures and had their disease activity found earlier.

Patients with stable eosinophilic esophagitis (EoE) should ideally have a follow-up assessment every 12 to 18 months in order to detect a relapse, according to a retrospective analysis of adult patients.

Although EoE is a chronic inflammatory disorder, recommendations are silent about optimal follow-up timing for patients whose disease is controlled with steroids.

In 2007, an EoE clinic for adults in Switzerland began monitoring patients according to a protocol developed by the team behind the current study, which was published earlier this year in the United European Gastroenterology Journal. In this Swiss center, clinical, endoscopic, and histological disease activity is assessed annually regardless of symptoms, in an effort to improve care and reduce costs, such as by reducing the need for emergency care for food impactions.

In this study, the researchers wanted to see how their concept for monitoring had been implemented, as well as if better follow-up improved outcomes.

These patients followed a previously published protocol of swallowed steroids of 1 mg twice a day until a response was seen (usually in about 2 to 4 weeks), followed by a long‐term maintenance phase, where they took 0.25 mg of steroid twice per day.

The long‐term phase continued regardless of remission; flares were treated with re‐induction therapy by returning to the original 1 mg dose of a swallowed steroid for up to 2 weeks.

Data from 159 adult patients (77.4%, or 123, were male) with a total of 309 follow‐up visits were analyzed. The mean (SD) age at diagnosis was 38.9 (15.4) years; participants had symptoms for a median of 5 (interquartile range [IQR], 2-11) years before they finally had a diagnosis.

Patients were classified as having close follow-up, with the timing between visits under 18 months, or longer follow‐up of 18 months or more.

Of the 309 visits, 157 visits were within a close follow‐up schedule (median of 1.0 years since last visit, IQR, 0.9–1.2), while 152 were not (2.9 years after last visit, IQR 2.0–4.1).

The formation of strictures was significantly less frequently seen at visits within a close follow‐up timeframe (22.9 vs 33.6%, P = .038).

However, the presence of symptoms did not suggest adherence to a close follow-up schedule, but female sex did (odds ratio, 1.583; 95% CI, 0.932-2.690, P = .089), although not to a significant degree.

A close follow‐up schedule also did not result in lower rates of disease activity.

The study had a number of limitations, such as adherence was unable to be graded in detail, prescription refills could not be determined, and mild to moderate disease might have been underestimated.

Reference

Bon L, Safroneeva E, Bussmann C, et al. Close follow‐up is associated with fewer stricture formation and results in earlier detection of histological relapse in the long‐term management of eosinophilic esophagitis. United European Gastroenterol J. 2022;10(3):308-318. doi:10.1002/ueg2.12216