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. 2021 Oct;161(4):1133-1144.
doi: 10.1053/j.gastro.2021.06.023. Epub 2021 Jun 19.

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

Tiffany H Taft  1 , Dustin A Carlson  2 , Madison Simons  2 , Sonia Zavala  2 , Ikuo Hirano  2 , Nirmala Gonsalves  2 , John E Pandolfino  2
Affiliations

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

Tiffany H Taft et al. Gastroenterology. 2021 Oct.

Abstract

Background & aims: Patient symptom reporting often does not correlate with the 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.

Methods: A retrospective review of an EoE patient registry was conducted and included eosinophils per high power field (from esophagogastroduodenoscopy biopsy: proximal, distal), endoscopic reference score, distal distensibility plateau (functional luminal imaging probe), Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, Northwestern Esophageal Quality of Life scale, and the Esophageal Hypervigilance and Anxiety Scale. Correlational and regression analyses evaluated relationships of hypervigilance and anxiety with Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, and Northwestern Esophageal Quality of Life scale when controlling for histology and endoscopic severity.

Results: One hundred and three patients had complete data, 69.9% were male, and the mean (SD) age was 40.66 (13.85) years. Forty-one percent had elevated dysphagia and 46% had elevated hypervigilance and anxiety. Esophageal symptom-specific anxiety emerged as the most important predictor of Brief Esophageal Dysphagia Questionnaire severity (44.8% of the variance), Visual Dysphagia Question of EoE Activity Index severity (26%), and poor health-related quality of life (HRQoL) (55.3%). Hypervigilance was also important, but to a lesser extent. Pathophysiological variables did not significantly predict symptoms or HRQoL. Recent food impaction can predict symptom-specific anxiety and proton pump inhibitor use can reduce hypervigilance.

Conclusions: Hypervigilance 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.

Keywords: Eosinophilic Esophagitis; Hypervigilance; Quality of Life; Symptom Severity; Symptom-Specific Anxiety.

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Conflict of interest statement

Conflict of Interest Statement: Dr. Taft reports 100% ownership interest in Oak Park Behavioral Medicine LLC; Dr. Hirano reports receiving research funding from Adare Pharmaceuticals, Allakos, Meritage Pharma Inc., Receptos/Celgene, Regeneron, and Shire, a Takeda company, and being a consultant for Adare Pharmaceuticals, Allakos, Arena Pharmaceuticals, AstraZeneca Meritage Pharma Inc., Receptos/Celgene, Regeneron, Gossamer Bio, Lilly, EsoCap, and Shire, a Takeda company; Dr. Gonsalves reports Consulting for Allakos, Astra Zeneca, Abbvie, Sanofi-Regeneron and Nutricia, as well as Up To Date Royalties; Dr. Pandolfino reports consulting and grant funding for Diversatek, Takeda, and Ironwood, and consulting and speaking for Ethicon and Endogastric ; Dr. Simons, Ms. Zavala, and Dr. Carlson have nothing to disclose.

Figures

Figure 1.
Figure 1.
Pearson’s Correlation Between Total Esophageal Hypervigilance and Anxiety and Dysphagia Symptoms and Difficulty Eating Foods
Figure 2.
Figure 2.
Pearson’s Correlation Between Total Esophageal Hypervigilance and Anxiety and HRQoL
See this image and copyright information in PMC

Comment in

References

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