目的:吞咽困难是嗜酸性粒细胞性食管炎(EoE)的标志性症状。然而,关于吞咽困难和胸骨后疼痛等非典型症状的总体患病率和潜在影响的数据有限.
方法:对参加瑞士EoE队列研究(SEECS)的患者进行了吞咽痛觉和胸骨后疼痛的分析。人口统计,其他EoE相关症状,比较了EoE患者的组织学和内镜活动与无吞咽困难和/或胸骨后疼痛。
结果:分析了474例患者(75.2%为男性)。在他们的个体病程中,有110例(23.2%)患者表示曾经经历过吞咽痛和64例(13.5%)胸骨后疼痛,与食物摄入无关。24(5%)患者抱怨这两种症状。吞咽困难患者的症状严重程度始终得分更高(p<0.001),EREFS评分(中位数3.0与2.0,p=0.006),与没有吞咽困难的患者相比,组织学活动和较低的生活质量(p=0.001)。性,诊断时的年龄,EoE特异性治疗,念珠菌或病毒性食管炎等并发症和疾病持续时间在患者中相似。没有食欲不振.胸骨后疼痛患者的症状严重程度得分较高(2.0vs.1.0,p=0.001和2.0与1.0,在医生和患者问卷评估中p<0.001,分别)。然而,根据是否存在胸骨后疼痛,内镜/组织学疾病活动和生活质量均无差异.由于后勤原因,不可能对伴随吞咽困难的存在进行分层.
结论:吞咽痛和独立于吞咽的胸骨后疼痛是EoE患者的常见症状,与整体较高的EoE相关症状严重程度相关,并且对于吞咽困难的情况,生活质量较低。然而,合并吞咽困难的影响及其严重程度尚不清楚,需要纳入未来的分析.
OBJECTIVE: Dysphagia is the hallmark symptom in eosinophilic esophagitis (EoE). However, data are limited regarding the overall prevalence and potential implications of atypical symptoms like odynophagia and retrosternal pain.
METHODS: Patients enrolled into the Swiss EoE cohort study (SEECS) were analyzed regarding the presence of odynophagia and retrosternal pain. Demographics, other EoE-related symptoms, histologic and endoscopic activity were compared between EoE-patients with vs. without odynophagia and/or retrosternal pain.
RESULTS: 474 patients (75.2% male) were analyzed. In their individual course of disease 110 (23.2%) patients stated to have ever experienced odynophagia and 64 (13.5%) retrosternal pain independent of food intake, 24 (5%) patients complained about both symptoms. Patients with odynophagia consistently scored higher in symptom severity (p < 0.001), EREFS score (median 3.0 vs. 2.0, p = 0.006), histologic activity and a lower quality of life (p = 0.001) compared to patients without odynophagia. Sex, age at diagnosis, EoE-specific treatment, complications such as candida or viral esophagitis and disease duration were similar in patients with vs. without odynophagia. Also patients with retrosternal pain scored higher in symptom severity (2.0 vs. 1.0, p = 0.001 and 2.0 vs. 1.0, p < 0.001 in physician and patient questionnaire assessment, respectively). However, there was neither a difference in endoscopic/histologic disease activity nor in quality of life according to presence or absence of retrosternal pain. Due to logistic reasons, a stratification regarding the presence of concomitant dysphagia was not possible.
CONCLUSIONS: Odynophagia and swallowing-independent retrosternal pain are common symptoms in patients with EoE, associate with an overall higher EoE-related symptom severity and for the case of odynophagia lower quality of life. However, the influence of concomitant dysphagia and its severity remains unclear and needs to be included in future analyses.