Esophageal Hypervigilance and Symptom Specific Anxiety in Patients with Eosinophilic Esophagitis.

Abstract

BACKGROUND AND AIMS\nPatient symptom reporting often does not correlate with pathophysiological markers of esophageal disease, including eosinophilic esophagitis (EoE). Esophageal hypervigilance and symptom-specific anxiety are emerging as important considerations in understanding symptom reporting. As such, we aimed to conduct the first study of these constructs in EoE.\n\n\nMETHODS\nA retrospective review of an EoE patient registry was conducted and included: 1) eosinophils per high power field (EOS/HPF from EGD biopsy: proximal, distal), 2) endoscopic reference score (EREFS), 3) distal distensibility plateau (FLIP), 4) Brief Esophageal Dysphagia Questionnaire (BEDQ), 5) Visual Dysphagia Question of EoE Activity Index (EEsAI-VDQ), 6) Northwestern Esophageal Quality of Life scale (NEQOL), 7) Esophageal Hypervigilance and Anxiety Scale (EHAS). Correlational and regression analyses evaluated relationships of hypervigilance and anxiety with BEDQ, EEsAI-VDQ, and NEQOL when controlling for histology and endoscopic severity.\n\n\nRESULTS\n103 patients had complete data: 69.9% male, average age of 40.66 (13.85) years. 41% had elevated dysphagia and 46% elevated hypervigilance and anxiety. Esophageal symptom-specific anxiety emerged as the most important predictor of BEDQ severity (44.8% of the variance), EEsAI-VDQ severity (26%), and poor HRQoL (55.3%). Hypervigilance was also important, to a lesser extent. Pathophysiological variables did not significantly predict symptoms or HRQoL. Recent food impaction may predict symptom-specific anxiety, while PPI use may reduce hypervigilance.\n\n\nCONCLUSION\nHypervigilance and symptom-specific anxiety are important for our understanding of self-reported patient outcomes in EoE. These processes outweigh endoscopic and histologic markers of EoE disease activity across dysphagia, difficulty eating, and HRQoL. Clinicians should assess hypervigilance and anxiety, especially in patients with refractory symptoms and poor HRQoL.