We performed a retrospective cohort analysis of patients at University of North Carolina (UNC) Hospitals from 2006–2013. Patients of any age with EoE were identified from the UNC EoE Clinicopathologic Database.[12 (link), 13 (link)] For inclusion, patients had to have EoE by consensus guidelines, including failure to respond to a PPI trial;[1 (link)–3 (link)] undergo treatment with swallowed topical corticosteroids (tCS) or dietary therapy; and have a follow up endoscopy with biopsy. Treatment with tCS consisted of either budesonide (0.5–1 mg twice daily, depending on patient age)[14 (link), 15 (link)] or fluticasone (440–880 mcg twice daily, depending on patient age).[16 (link)–18 (link)] Dietary therapy consisted of six food elimination diets or targeted elimination diets.[19 (link)–21 (link)] Patients were treated with either tCS or dietary elimination for approximately 8 weeks prior to reassessment with esophagogastroduodenoscopy (EGD). For patients undergoing serial therapeutic trials of pharmacologic treatment modalities (for example fluticasone followed by budesonide), the results from the trial resulting in the lowest post-treatment eosinophil count were used for analysis. For patients undergoing sequential trials of dietary and steroid therapy (for example, dietary therapy after steroid therapy had failed), each therapeutic outcome was included. When a patient had outcomes for both dietary and steroid therapy, the eosinophil count from the diagnostic pre-treatment EGD was used to determine the percentage change in eosinophils.
Data were abstracted from the UNC electronic medical record. Using standardized data collection tools, we recorded patient demographics, symptoms, comorbidities, baseline and follow-up endoscopy findings, baseline and follow-up eosinophil counts on esophageal biopsy, and therapeutic regimen. Pre- and post-treatment eosinophil counts were recorded as the maximum number of eosinophils per high-power field (eos/hpf; hpf size = 0.24mm2) from pathologist review. Treatment outcomes were defined as follows: symptom response (dichotomous patient-reported subjective improvement [yes/no]); endoscopic response (dichotomous endoscopist-reported assessment of improvement [yes/no]), and both symptom and endoscopic response.
Data were abstracted from the UNC electronic medical record. Using standardized data collection tools, we recorded patient demographics, symptoms, comorbidities, baseline and follow-up endoscopy findings, baseline and follow-up eosinophil counts on esophageal biopsy, and therapeutic regimen. Pre- and post-treatment eosinophil counts were recorded as the maximum number of eosinophils per high-power field (eos/hpf; hpf size = 0.24mm2) from pathologist review. Treatment outcomes were defined as follows: symptom response (dichotomous patient-reported subjective improvement [yes/no]); endoscopic response (dichotomous endoscopist-reported assessment of improvement [yes/no]), and both symptom and endoscopic response.
