title: Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years.
abstract: OBJECTIVE
  Primary eosinophilic esophagitis is a chronic, increasingly recognized, interleukin 5-driven inflammatory disorder of the esophagus. The leading symptom in adults is uniform attacks of dysphagia, and the established histologic sign is a dense eosinophilic infiltration of the esophageal epithelium. Before this study, the natural course of eosinophilic esophagitis had not been defined and information regarding potential long-term risks was lacking.
  
  
  METHODS
  This prospective case series included 30 adult patients with eosinophilic esophagitis (22 men and 8 women; mean age, 40.6 years) whose diagnosis had been made >1 year before study debut based on typical history, consistent endoscopic abnormalities, and infiltration of the esophageal epithelium with >24 eosinophils/high-power field. After a mean of 7.2 years, patients underwent a comprehensive follow-up examination.
  
  
  RESULTS
  All patients survived the study period in good health and stable nutritional state. Dysphagia persisted in 29 patients, exerting a major negative effect on socioprofessional activities on 1 patient and a minor impact on 15. Attacks of dysphagia were more frequent in patients with blood eosinophilia or pronounced endoscopic alterations. The esophageal eosinophilic infiltration persisted in all symptomatic patients, but cell numbers spontaneously decreased significantly (78.7 vs. 40.3 cells/high-power field). The inflammatory process evoked fibrosis of the esophageal lamina propria but did not spread to the stomach or duodenum. No case evolved to a hypereosinophilic syndrome.
  
  
  CONCLUSIONS
  Eosinophilic esophagitis, a primary and chronic disease restricted to the esophagus, leads to persistent dysphagia and structural esophageal alterations but does not impact the nutritional state. To date, no malignant potential has been associated with this disease.
authors.affiliation: Department of Gastroenterology, Kantonsspital, Olten, Switzerland. alex.straumann@hin.ch
authors.forename: Alex
authors.initials: A
authors.lastname: Straumann
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Spichtin
authors.forename: Leticia
authors.initials: L
authors.lastname: Grize
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Bucher
authors.forename: Christoph
authors.initials: C
authors.lastname: Beglinger
authors.forename: Hans-Uwe
authors.initials: HU
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004802:Eosinophilia / Q000473:pathology*; D004941:Esophagitis / Q000473:pathology*; D004947:Esophagus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged