Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2024; 30(2): 146-157
Published online Jan 14, 2024. doi: 10.3748/wjg.v30.i2.146
Long-term prognosis and its associated predictive factors in patients with eosinophilic gastroenteritis
Kai-Wen Li, Ge-Chong Ruan, Shuang Liu, Tian-Ming Xu, Ye Ma, Wei-Xun Zhou, Wei Liu, Peng-Yu Zhao, Zhi-Rong Du, Ji Li, Jing-Nan Li
Kai-Wen Li, Ge-Chong Ruan, Tian-Ming Xu, Ye Ma, Ji Li, Jing-Nan Li, Department of Gastroenterology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
Shuang Liu, Zhi-Rong Du, Department of Allergy, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
Wei-Xun Zhou, Department of Pathology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
Wei Liu, Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
Peng-Yu Zhao, Affairs Office, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital (West campus), Beijing 100032, China
Co-first authors: Kai-Wen Li and Ge-Chong Ruan.
Co-corresponding authors: Ji Li and Jing-Nan Li.
Author contributions: Li KW, Ruan GC, Li J and Li JN designed the study; Li KW, Ruan GC, Zhou WX and Liu W acquired and analyzed the data; Liu S, Xu TM, Ma Y and Du ZR helped with patient follow-up; Zhao PY contributed to the statistical methodology; Li J and Li JN provided resources and acquired funding; Li KW, Ruan GC, Li J and Li JN wrote the paper. During the course of this study, Li KW and Ruan GC made equal contributions across various stage. Their involvement encompassed the design of the study, selection of patients, collection of baseline data, follow-up via telephone calls and outpatient services, as well as data analysis and the drafting of the article, thus leading to shared first authorship. Furthermore, the study also benefited from the substantial contributions of Li J and Li JN. They played equally vital roles in the process of study design, funding support, article writing and reviewing, thereby sharing co-correspondence authorship. These collaborative efforts have been instrumental in shaping the final outcome of this work.
Supported by National High Level Hospital Clinical Research Funding, No. 2022-PUMCH-B-022; CAMS Innovation Fund for Medical Sciences, No. CIFMS 2021-1-I2M-003; and Undergraduate Innovation Program, No. 2023zglc06076.
Institutional review board statement: The study was reviewed and approved by the Chinese Academy of Medical Sciences and Peking Union Medical College Hospital Institutional Review Board (Approval No. I-23PJ1227).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji Li, MD, Doctor, Department of Gastroenterology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Beijing 100730, China. liji0235@pumch.cn
Received: August 22, 2023
Peer-review started: August 22, 2023
First decision: November 20, 2023
Revised: November 28, 2023
Accepted: December 25, 2023
Article in press: December 25, 2023
Published online: January 14, 2024
Abstract
BACKGROUND

Eosinophilic gastroenteritis (EGE) is a chronic recurrent disease with abnormal eosinophilic infiltration in the gastrointestinal tract. Glucocorticoids remain the most common treatment method. However, disease relapse and glucocorticoid dependence remain notable problems. To date, few studies have illuminated the prognosis of EGE and risk factors for disease relapse.

AIM

To describe the clinical characteristics of EGE and possible predictive factors for disease relapse based on long-term follow-up.

METHODS

This was a retrospective cohort study of 55 patients diagnosed with EGE admitted to one medical center between 2013 and 2022. Clinical records were collected and analyzed. Kaplan-Meier curves and log-rank tests were conducted to reveal the risk factors for long-term relapse-free survival (RFS).

RESULTS

EGE showed a median onset age of 38 years and a slight female predominance (56.4%). The main clinical symptoms were abdominal pain (89.1%), diarrhea (61.8%), nausea (52.7%), distension (49.1%) and vomiting (47.3%). Forty-three (78.2%) patients received glucocorticoid treatment, and compared with patients without glucocorticoid treatments, they were more likely to have elevated serum immunoglobin E (IgE) (86.8% vs 50.0%, P = 0.022) and descending duodenal involvement (62.8% vs 27.3%, P = 0.046) at diagnosis. With a median follow-up of 67 mo, all patients survived, and 56.4% had at least one relapse. Six variables at baseline might have been associated with the overall RFS rate, including age at diagnosis < 40 years [hazard ratio (HR) 2.0408, 95% confidence interval (CI): 1.0082–4.1312, P = 0.044], body mass index (BMI) > 24 kg/m2 (HR 0.3922, 95%CI: 0.1916-0.8027, P = 0.014), disease duration from symptom onset to diagnosis > 3.5 mo (HR 2.4725, 95%CI: 1.220-5.0110, P = 0.011), vomiting (HR 3.1259, 95%CI: 1.5246-6.4093, P = 0.001), total serum IgE > 300 KU/L at diagnosis (HR 0.2773, 95%CI: 0.1204-0.6384, P = 0.022) and glucocorticoid treatment (HR 6.1434, 95%CI: 2.8446-13.2676, P = 0.003).

CONCLUSION

In patients with EGE, younger onset age, longer disease course, vomiting and glucocorticoid treatment were risk factors for disease relapse, whereas higher BMI and total IgE level at baseline were protective.

Keywords: Eosinophilic gastroenteritis, Prognosis, Relapse, Glucocorticoid, Glucocorticoid dependence

Core Tip: Disease relapse has been a long-standing concern for patients with eosinophilic gastroenteritis (EGE). Limited evidence has shown that predicting the course of EGE is complex and related to many factors. There is an urgent need to understand the long-term prognosis of EGE. Therefore, we aimed to describe the features of Chinese EGE patients and construct a model to predict disease relapse based on baseline clinical characteristics.