title: Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner.
abstract: OBJECTIVE
  Development of strictures is a major concern for patients with eosinophilic esophagitis (EoE). At diagnosis, EoE can present with an inflammatory phenotype (characterized by whitish exudates, furrows, and edema), a stricturing phenotype (characterized by rings and stenosis), or a combination of these. Little is known about progression of stricture formation; we evaluated stricture development over time in the absence of treatment and investigated risk factors for stricture formation.
  
  
  METHODS
  We performed a retrospective study using the Swiss EoE Database, collecting data on 200 patients with symptomatic EoE (153 men; mean age at diagnosis, 39 ± 15 years old). Stricture severity was graded based on the degree of difficulty associated with passing of the standard adult endoscope.
  
  
  RESULTS
  The median delay in diagnosis of EoE was 6 years (interquartile range, 2-12 years). With increasing duration of delay in diagnosis, the prevalence of fibrotic features of EoE, based on endoscopy, increased from 46.5% (diagnostic delay, 0-2 years) to 87.5% (diagnostic delay, >20 years; P = .020). Similarly, the prevalence of esophageal strictures increased with duration of diagnostic delay, from 17.2% (diagnostic delay, 0-2 years) to 70.8% (diagnostic delay, >20 years; P < .001). Diagnostic delay was the only risk factor for strictures at the time of EoE diagnosis (odds ratio = 1.08; 95% confidence interval: 1.040-1.122; P < .001).
  
  
  CONCLUSIONS
  The prevalence of esophageal strictures correlates with the duration of untreated disease. These findings indicate the need to minimize delay in diagnosis of EoE.
authors: Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois / CHUV, Lausanne, Switzerland. Electronic address: alain.schoepfer@chuv.ch.
authors: Alain M
authors: AM
authors: Schoepfer
authors: Ekaterina
authors: E
authors: Safroneeva
authors: Christian
authors: C
authors: Bussmann
authors: Tanja
authors: T
authors: Kuchen
authors: Susanne
authors: S
authors: Portmann
authors: Hans-Uwe
authors: HU
authors: Simon
authors: Alex
authors: A
authors: Straumann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000009:adverse effects*; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000175:diagnosis*; D004940:Esophageal Stenosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: CI; Complications; EoE; Esophagus; IQR; Inflammation; OR; Remodeling; SEED; Swiss EoE database; confidence interval; eosinophilic esophagitis; interquartile range; odds ratio