title: A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease.
abstract: BACKGROUND
  Phenotypes of eosinophilic esophagitis (EoE) are not well-characterized.
  
  
  OBJECTIVE
  To describe clinical features of patients with EoE with predefined phenotypes, determine predictors of these phenotypes, and make inferences about the natural history of EoE.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary-care center.
  
  
  METHODS
  Incident EoE cases from 2001 to 2011 that met consensus diagnostic guidelines.
  
  
  METHODS
  Review of records.
  
  
  METHODS
  Endoscopic phenotypes, including fibrostenotic, inflammatory, or mixed. Other groups of clinical characteristics examined included atopy, level of esophageal eosinophilia, and age of symptom onset. Multinomial logistic regression assessed predictors of phenotype status.
  
  
  RESULTS
  Of 379 cases of EoE identified, there were no significant phenotypic differences by atopic status or level of eosinophilia. Those with the inflammatory phenotype were more likely to be younger than those with mixed or fibrostenotic (13 vs 29 vs 39 years, respectively; P < .001) and less likely to have dysphagia, food impaction, and esophageal dilation (P < .001 for all). The mean symptom length before diagnosis was shorter for inflammatory (5 vs 8 vs 8 years; P = .02). After multivariate analysis, age and dysphagia independently predicted phenotype. The odds ratio (OR) for fibrostenosis for each 10-year increase in age was 2.1 (95% CI, 1.7-2.7). The OR for dysphagia was 7.0 (95% CI, 2.6-18.6).
  
  
  CONCLUSIONS
  Retrospective, single-center study.
  
  
  CONCLUSIONS
  In this large EoE cohort, the likelihood of fibrostenotic disease increased markedly with age. For every 10-year increase in age, the odds of having a fibrostenotic EoE phenotype more than doubled. This association suggests that the natural history of EoE is a progression from an inflammatory to a fibrostenotic disease.
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Hannah P
authors.initials: HP
authors.lastname: Kim
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Sarah L W
authors.initials: SL
authors.lastname: Sperry
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Rybnicek
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Woosley
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000235:genetics; D004940:Esophageal Stenosis / Q000150:complications; D004947:Esophagus / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies; D055815:Young Adult