Hypervigilance and Symptom-Specific Anxiety in Patients With Eosinophilic Esophagitis

Among patients with eosinophilic esophagitis (EoE), hypervigilance and symptom-specific anxiety are important for understanding self-reported patient outcomes, according to study results published in Gastroenterology.

Increasingly, hypervigilance and symptom-specific anxiety are being recognized as important considerations for patient reported outcomes in esophageal disease and may explain dysphagia symptoms better than physiological data. To investigate, a retrospective review of an EoE patient registry was conducted.

A total of 103 patients had complete data for the following 7 parameters and questionnaires and were included in the analysis: eosinophils per high power field , endoscopic reference score (EREFS), distal distensibility plateau (FLIP), Brief Esophageal Dysphagia Questionnaire (BEDQ), Visual Dysphagia Question of EoE Activity Index (EEsAI-VDQ), Northwestern Esophageal Quality of Life scale (NEQOL), and Esophageal Hypervigilance and Anxiety Scale (EHAS).

The majority of patients were male (69.9%) and the average age was 40.66 years. The primary reason most patients presented for esophagogastroduodenoscopy (EGD) was dysphagia (73%), with very few reporting heartburn/reflux (4.9%) or chest pain (1.9%).

Symptom-specific anxiety and hypervigilance were significant predictors of dysphagia symptoms, difficulty swallowing different foods, and poorer health-related quality of life (HRQOL). The most important predictor of BEDQ severity, EEsAI-VDQ severity, and poor HRQOL was esophageal symptom-specific anxiety, accounting for 44.8%, 26%, and 55.3% of variance, respectively. Hypervigilance was important, though to a lesser extent.

Recent food impaction was a significant predictor of increased symptom-specific anxiety, but not hypervigilance. Use of proton-pump inhibitors was a predictor of less hypervigilance.

This study was not without limitations. Though study data were collected prospectively, they were reviewed retrospectively. Additionally, data were collected from a single center, were cross-sectional in nature, and only assessed the 4 weeks prior to collection. Demographic data were not collected and thus associations with hypervigilance and anxiety could not be assessed. All questionnaires were completed before EGD and FLIP procedures, which may have amplified anxiety scores. No post-procedure measurements were performed to account for this.

According to researchers, “Hypervigilance to, and anxiety about, EoE symptoms are important clinical considerations when evaluating patient outcomes that should be routinely evaluated.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Taft TH, Carlson DA, Simons M, et al. Esophageal hypervigilance and symptom specific anxiety in patients with eosinophilic esophagitis. Gastroenterol. Published online June 18, 2021. doi:10.1053/j.gastro.2021.06.023

This article originally appeared on Gastroenterology Advisor