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Mo1867 Clinical Outcomes of Rescue Treatment for Eosinophilic Esophagitis
AGA Abstracts
aims to determine if dietary treatments affect HRQOL in this patient population. Methods: EGID patients were recruited online via social media and patient organizations (CURED, APFED). Screening questions evaluated the presence of an EGID. Qualified participants completed the Eosinophilic Esophagitis Quality of Life Questionnaire for Adults (EoE-QOLA) which measures 5 domains: eating anxiety (EAT), social withdrawal (SOC), emotional distress (EMO), disease anxiety (DA), and swallowing anxiety (SA), and several demographic and clinical questions: age, gender, race, ethnicity, marital status, diagnosis duration (DxD), self-rated disease severity (DSev), and dietary treatment (DietTx). Relationships between variables were evaluated via Pearson's correlation, independent samples t-Test, and stepwise multiple regression analyses. Results: 139 participants completed the study (75% EoE). 80% were female, 55% married, 94% Caucasian and non-Hispanic, with an average age of 36.9 years. Mean(SD) DxD was 3.7(3.9) years. Average DSev was 6.7(2.1) out of 10. 56% were currently using DietTx. Females reported poorer EMO (p=.006), DA (p=.04), and SA (p=.01). No differences existed by age, marital status, race, or ethnicity. Patients with a shorter DxD reported poorer EAT (r=-.22, p=.02), EMO (r=-.21, p=.02), and DA (r=-.30,p= .001); those with greater DSev had poorer EAT and SOC (both r=-.20, p=.02), and EMO (r=-.25, p=.005). Patients using dietary treatments reported poorer EAT (p=.001) and EMO (p=.02). Regression analyses revealed that DietTx significantly predicts poorer EAT (9% of the variance), followed by DxD (6%), and DSev (2%); gender was not significant. For EMO, DSev was the largest predictor (7%), followed by gender (6%), and DxD (4%). DietTx was not significant. Conclusions: Dietary treatment for EGIDs has limited impact on HRQOL. While significant differences exist for eating anxiety and social withdrawal, only eating anxiety is predicted by dietary treatment use when controlling for gender, diagnosis duration, and symptom severity. Practitioners should be mindful of the effects of dietary treatment on eating anxiety and work with patients to mitigate these concerns.
severity positively correlated with medication adherence (r=.25, p=.009). Physician relationship did not correlate with either adherence category. Demographic differences only existed for diet adherence, with married patients more likely to adhere (p=.04) and unemployed patients less likely to adhere (p=.004). Age, gender, education, and income were not significant. No significant interaction effects existed between gender/marital status and employment/ income. Patients who had seen a dietitian had better diet adherence, although only approaching significance (p=.07). Depression, anxiety, and HRQOL were not significantly correlated with adherence. Conclusions: EGID patients report good treatment adherence rates (81% for medications, 74% for diet). Treatment satisfaction and symptom severity are positively correlated with adherence, while the quality of physician relationship was not significant. Unemployed patients may struggle with adhering to diet treatments, but not necessarily due to financial reasons. Interestingly, patients who have seen a dietitian were not significantly more likely to adhere to EGID diets. Further inquiry into treatment adherence in the EGIDs is needed. Mo1866 Internalized Stigma and Stigma Resistance in the Eosinophilic Gastrointestinal Disorders (EGIDs) Tiffany Taft, Laurie Keefer Introduction: Chronic illness stigma has yet to be evaluated in patients with EGIDs; specifically, the potential of internalized stigma (IS), or belief that negative attitudes about oneself or disease are true, to negatively influence EGID patient outcomes. Historically, IS predicts poorer psychological health, social functioning, and treatment adherence. Resistance to IS can serve to buffer these negative effects. We sought to evaluate IS and resistance in the EGIDs, and their relationship with patient outcomes. Methods: Patients were recruited via patient organizations (APFED, CURED) and online sources (social media, support groups). Screening questions established an EGID diagnosis. Eligible participants completed the Internalized Stigma Scale for Mental Illness (modified for EGIDs) which measures levels of alienation (ALI), social withdrawal (SOC), stereotype endorsement (STER), discrimination experiences (DISC), and stigma resistance (RES) with established cutoff scores for minimal, mild, moderate and high stigma levels. Other measures included the NIH-PROMIS anxiety and depression scales, eosinophilic esophagitis (EoE) quality of life scale for adults, and demographic and clinical information. Results: 110 patients participated (75% EoE). The sample majority was white (94%), female (80%), married (55%), and college educated (64%) with a mean age of 36.9 years. EGID patients report mild IS for ALI (M=2.1 (0.67)) and SOC (M=2.0 (0.73), and minimal IS for STER (M=1.5 (0.43)) and DISC (M=1.7 (0.63)). RES amongst EGID patients is high (M=3.2 (0.51)). ALI was higher for women (p=.01) and patients using dietary treatments (p=.01). Similar differences existed for SOC (women p= .04, dietary tx p=.001) and DISC (women p=.02, dietary tx p=.002). No differences existed by gender for dietary treatment. Patients who were once misdiagnosed reported greater STER (p=.03). All IS subscales are significantly correlated with increased anxiety (rs= 0.44 to 0.55) and depression (rs= 0.49 to 0.70), and reduced HRQOL (rs= 0.38 to 0.59) (all p= .000). RES was correlated with less depression (r= -0.22, p=.17) and anxiety (r= -0.22, p= .18) but did not correlate with HRQOL. No relationships existed between IS, RES, and treatment adherence. Conclusions: EGID patients report minimal to mild internalized stigma with alienation and social withdrawal occurring more often than stereotype endorsement and discrimination experiences. Stigma resistance is high in this patient population. Internalized stigma is higher in women and patients using dietary treatments. Poorer psychological functioning and reduced HRQOL, but not treatment adherence, correlate with internalized stigma. Stigma resistance is related to less depression and anxiety. Further inquiry into EGID stigma is needed.
Mo1864 Healthcare Utilization and Health Related Quality of Life in the Eosinophilic Gastrointestinal Disorders Tiffany Taft, Laurie Keefer Introduction: Healthcare utilization (HCU) is an important economic consideration in chronic illness management. Several factors affect HCU, including health related quality of life (HRQOL), disease severity, and treatment satisfaction. This is the first study to evaluate the relationship between HRQOL, HCU and patient variables amongst patients living with EGIDs. Methods: EGID patients recruited via social media and patient organizations (CURED, APFED) were screened for the presence of an EGID. Qualified participants completed the Eosinophilic Esophagitis Quality of Life Questionnaire for Adults (EoE-QOL-A) which measures 5 domains: eating anxiety (EAT), social withdrawal (SOC), emotional distress (EMO), disease anxiety (DA), and swallowing anxiety (SA). Demographic and clinical variables include: age, gender, race, ethnicity, marital status, diagnosis duration (DxD), selfreported disease severity (DSev), and treatment satisfaction (TxSat). Healthcare utilization (HCU) variables include: outpatient visits (OPV), endoscopic procedures (ENDO), emergency room (ER) visits, and number of current medications. Relationships between variables were evaluated via Pearson's correlation and stepwise multiple regression analyses. Results: 139 participants completed the study. 80% were female, 55% married, 94% Caucasian and nonHispanic, with an average age of 36.9 years. 75% had Eosinophilic Esophagitis. Mean(SD) DxD was 3.7(3.9) years. Average DSev was 6.7(2.1) out of 10. In the past year, patients had 9.1(13.6) OPV, 2.0(2.2) ENDO, and .71(1.5) ER visits. They were taking 2.2(2.4) medications and rated their TxSat at 6.4(2.8) out of 10. No differences existed by gender, marital status, race, or ethnicity for HCU. Significant correlations existed between HRQOL and HCU with EMO relating to OPV (r=.23, p=.008), ENDO (r=.21, p=.02), and medications (r=.20, p=.03). DA correlated with OPV (r=.24, p=.006) and EAT correlated with ENDO (r=.21, p=.02). No significant correlations existed between HRQOL and ER use. Regression analyses revealed predictive relationships between HRQOL and HCU: DA predicts OPV (6% of variance) when controlling for age and TxSat, EMO predicts number of medications (4%) when controlling for age and DSev, and EAT predicts number of ENDO (3%) when controlling for DSev. Conclustions: Our findings suggest that HRQOL may predict healthcare utilization amongst EGID patients. Specifically, patients with poorer HRQOL report more outpatient appointments, endoscopies, and take more medications. The variance in these scores explained by HRQOL was small, ranging from 3% to 6%. However, practitioners should evaluate HRQOL in their EGID patients and consider the role it may play in HCU. Further investigation is warranted.
Mo1867 Clinical Outcomes of Rescue Treatment for Eosinophilic Esophagitis John Leung, Raman Mehrzad, Alexandra R. Alejos, Paul E. Hesterberg, Qian Yuan, Navneet Virk Hundal, Wayne G. Shreffler, Aubrey J. Katz INTRODUCTION: One third of patients with eosinophilic esophagitis (EoE) do not achieve histological remission with standard medical or dietary treatment. The outcome of these patients undergoing various rescue treatments is not known. OBJECTIVE: To analyze EoE treatment outcomes in a pediatric population, including after initial treatment failure (rescue treatment). METHODS: We identified 100 serial cases of confirmed EoE from our Redcap database established at Massachusetts General Hospital starting from January 2007. Demographic data, clinical symptoms, treatment regimens, endoscopic findings, skin testing results, food triggers and clinical outcome of various rescue treatment strategies were presented. We defined clinical response as histological remission with peak eosinophil count of at least 6 biopsies less than 10 per high power field. RESULTS: Ninety-seven EoE patients underwent initial treatments. Eighty one (84%) elected dietary treatment (7 elemental diet, 54 multiple elimination diet, and 20 single milk elimination diet) and 16 (16%) elected medical treatment (15 fluticasone and 1 budesonide). Initial response rate to dietary and medical treatment was 66% (53/80) and 56% (9/16) respectively. Of the 34 who failed initial treatment, 24 of them elected various second treatment regimens (3 medical therapy, 2 milk-free diet, 14 multiple food elimination diet and 5 elemental diet) and 50% (11/22, 2 pending results) achieved histological remission. Eight of the remaining 11 who failed second treatment underwent additional treatments and 2 ultimately achieved histological remission. The overall response rate with intention to treat increased from 65% (62/96) with initial treatment to 78% (73/94) with rescue treatment, and further to 83% (75/90) with multiple rescue treatments. CONCLUSION: Half of the patients who failed initial EoE treatment could still achieve histological remission with rescue treatments.
Mo1865 Treatment Adherence in the Eosinophilic Gastrointestinal Disorders Tiffany Taft, Laurie Keefer Introduction: Treatment adherence is a salient issue when managing chronic illness. Patients with EGIDs typically utilize dietary approaches, prescription medications, or a combination of the two. We conducted exploratory analyses to identify potential variables that may influence treatment adherence in EGID patients, including the relationships with psychological distress, health related quality of life (HRQOL), disease severity, and demographics. Methods: EGID patients were recruited online and via patient organizations. Screening questions established presence of EGID. Qualified participants completed: sociodemographic variables (age, gender, race, ethnicity, marital status, income, education, employment), symptom severity, treatment satisfaction, treatment adherence in past week, dietitian consultation, and quality of physician relationship. HRQOL was evaluated via the Eosinophilic Esophagitis Quality of Life Scale for Adults and psychological distress via the NIH-PROMIS depression and anxiety scales. Results: 139 participants completed the study: mean(SD) age was 36.9(10.1) years, 94% white, non-Hispanic, 80% female, 55% married, 64% college educated, 16% unemployed, 54% household income $50,000 or higher. Mean diagnosis duration was 3.8(3.9) years with 6.7(2.0) symptom severity rating out of 10. Patients rated the quality of relationship with their physician 7.0(3.1) and treatment satisfaction 6.4(2.8) (both out of 10). 45% had seen a dietitian for EGID. Treatment adherence (out of 100) in the past week were 81.1(29.8) for medication and 73.9(32) for diet. Modest correlations exist between diet treatment adherence and treatment satisfaction (r=.30, p=.003). Symptom
AGA Abstracts
S-676
aims to determine if dietary treatments affect HRQOL in this patient population. Methods: EGID patients were recruited online via social media and patient organizations (CURED, APFED). Screening questions evaluated the presence of an EGID. Qualified participants completed the Eosinophilic Esophagitis Quality of Life Questionnaire for Adults (EoE-QOLA) which measures 5 domains: eating anxiety (EAT), social withdrawal (SOC), emotional distress (EMO), disease anxiety (DA), and swallowing anxiety (SA), and several demographic and clinical questions: age, gender, race, ethnicity, marital status, diagnosis duration (DxD), self-rated disease severity (DSev), and dietary treatment (DietTx). Relationships between variables were evaluated via Pearson's correlation, independent samples t-Test, and stepwise multiple regression analyses. Results: 139 participants completed the study (75% EoE). 80% were female, 55% married, 94% Caucasian and non-Hispanic, with an average age of 36.9 years. Mean(SD) DxD was 3.7(3.9) years. Average DSev was 6.7(2.1) out of 10. 56% were currently using DietTx. Females reported poorer EMO (p=.006), DA (p=.04), and SA (p=.01). No differences existed by age, marital status, race, or ethnicity. Patients with a shorter DxD reported poorer EAT (r=-.22, p=.02), EMO (r=-.21, p=.02), and DA (r=-.30,p= .001); those with greater DSev had poorer EAT and SOC (both r=-.20, p=.02), and EMO (r=-.25, p=.005). Patients using dietary treatments reported poorer EAT (p=.001) and EMO (p=.02). Regression analyses revealed that DietTx significantly predicts poorer EAT (9% of the variance), followed by DxD (6%), and DSev (2%); gender was not significant. For EMO, DSev was the largest predictor (7%), followed by gender (6%), and DxD (4%). DietTx was not significant. Conclusions: Dietary treatment for EGIDs has limited impact on HRQOL. While significant differences exist for eating anxiety and social withdrawal, only eating anxiety is predicted by dietary treatment use when controlling for gender, diagnosis duration, and symptom severity. Practitioners should be mindful of the effects of dietary treatment on eating anxiety and work with patients to mitigate these concerns.
severity positively correlated with medication adherence (r=.25, p=.009). Physician relationship did not correlate with either adherence category. Demographic differences only existed for diet adherence, with married patients more likely to adhere (p=.04) and unemployed patients less likely to adhere (p=.004). Age, gender, education, and income were not significant. No significant interaction effects existed between gender/marital status and employment/ income. Patients who had seen a dietitian had better diet adherence, although only approaching significance (p=.07). Depression, anxiety, and HRQOL were not significantly correlated with adherence. Conclusions: EGID patients report good treatment adherence rates (81% for medications, 74% for diet). Treatment satisfaction and symptom severity are positively correlated with adherence, while the quality of physician relationship was not significant. Unemployed patients may struggle with adhering to diet treatments, but not necessarily due to financial reasons. Interestingly, patients who have seen a dietitian were not significantly more likely to adhere to EGID diets. Further inquiry into treatment adherence in the EGIDs is needed. Mo1866 Internalized Stigma and Stigma Resistance in the Eosinophilic Gastrointestinal Disorders (EGIDs) Tiffany Taft, Laurie Keefer Introduction: Chronic illness stigma has yet to be evaluated in patients with EGIDs; specifically, the potential of internalized stigma (IS), or belief that negative attitudes about oneself or disease are true, to negatively influence EGID patient outcomes. Historically, IS predicts poorer psychological health, social functioning, and treatment adherence. Resistance to IS can serve to buffer these negative effects. We sought to evaluate IS and resistance in the EGIDs, and their relationship with patient outcomes. Methods: Patients were recruited via patient organizations (APFED, CURED) and online sources (social media, support groups). Screening questions established an EGID diagnosis. Eligible participants completed the Internalized Stigma Scale for Mental Illness (modified for EGIDs) which measures levels of alienation (ALI), social withdrawal (SOC), stereotype endorsement (STER), discrimination experiences (DISC), and stigma resistance (RES) with established cutoff scores for minimal, mild, moderate and high stigma levels. Other measures included the NIH-PROMIS anxiety and depression scales, eosinophilic esophagitis (EoE) quality of life scale for adults, and demographic and clinical information. Results: 110 patients participated (75% EoE). The sample majority was white (94%), female (80%), married (55%), and college educated (64%) with a mean age of 36.9 years. EGID patients report mild IS for ALI (M=2.1 (0.67)) and SOC (M=2.0 (0.73), and minimal IS for STER (M=1.5 (0.43)) and DISC (M=1.7 (0.63)). RES amongst EGID patients is high (M=3.2 (0.51)). ALI was higher for women (p=.01) and patients using dietary treatments (p=.01). Similar differences existed for SOC (women p= .04, dietary tx p=.001) and DISC (women p=.02, dietary tx p=.002). No differences existed by gender for dietary treatment. Patients who were once misdiagnosed reported greater STER (p=.03). All IS subscales are significantly correlated with increased anxiety (rs= 0.44 to 0.55) and depression (rs= 0.49 to 0.70), and reduced HRQOL (rs= 0.38 to 0.59) (all p= .000). RES was correlated with less depression (r= -0.22, p=.17) and anxiety (r= -0.22, p= .18) but did not correlate with HRQOL. No relationships existed between IS, RES, and treatment adherence. Conclusions: EGID patients report minimal to mild internalized stigma with alienation and social withdrawal occurring more often than stereotype endorsement and discrimination experiences. Stigma resistance is high in this patient population. Internalized stigma is higher in women and patients using dietary treatments. Poorer psychological functioning and reduced HRQOL, but not treatment adherence, correlate with internalized stigma. Stigma resistance is related to less depression and anxiety. Further inquiry into EGID stigma is needed.
Mo1864 Healthcare Utilization and Health Related Quality of Life in the Eosinophilic Gastrointestinal Disorders Tiffany Taft, Laurie Keefer Introduction: Healthcare utilization (HCU) is an important economic consideration in chronic illness management. Several factors affect HCU, including health related quality of life (HRQOL), disease severity, and treatment satisfaction. This is the first study to evaluate the relationship between HRQOL, HCU and patient variables amongst patients living with EGIDs. Methods: EGID patients recruited via social media and patient organizations (CURED, APFED) were screened for the presence of an EGID. Qualified participants completed the Eosinophilic Esophagitis Quality of Life Questionnaire for Adults (EoE-QOL-A) which measures 5 domains: eating anxiety (EAT), social withdrawal (SOC), emotional distress (EMO), disease anxiety (DA), and swallowing anxiety (SA). Demographic and clinical variables include: age, gender, race, ethnicity, marital status, diagnosis duration (DxD), selfreported disease severity (DSev), and treatment satisfaction (TxSat). Healthcare utilization (HCU) variables include: outpatient visits (OPV), endoscopic procedures (ENDO), emergency room (ER) visits, and number of current medications. Relationships between variables were evaluated via Pearson's correlation and stepwise multiple regression analyses. Results: 139 participants completed the study. 80% were female, 55% married, 94% Caucasian and nonHispanic, with an average age of 36.9 years. 75% had Eosinophilic Esophagitis. Mean(SD) DxD was 3.7(3.9) years. Average DSev was 6.7(2.1) out of 10. In the past year, patients had 9.1(13.6) OPV, 2.0(2.2) ENDO, and .71(1.5) ER visits. They were taking 2.2(2.4) medications and rated their TxSat at 6.4(2.8) out of 10. No differences existed by gender, marital status, race, or ethnicity for HCU. Significant correlations existed between HRQOL and HCU with EMO relating to OPV (r=.23, p=.008), ENDO (r=.21, p=.02), and medications (r=.20, p=.03). DA correlated with OPV (r=.24, p=.006) and EAT correlated with ENDO (r=.21, p=.02). No significant correlations existed between HRQOL and ER use. Regression analyses revealed predictive relationships between HRQOL and HCU: DA predicts OPV (6% of variance) when controlling for age and TxSat, EMO predicts number of medications (4%) when controlling for age and DSev, and EAT predicts number of ENDO (3%) when controlling for DSev. Conclustions: Our findings suggest that HRQOL may predict healthcare utilization amongst EGID patients. Specifically, patients with poorer HRQOL report more outpatient appointments, endoscopies, and take more medications. The variance in these scores explained by HRQOL was small, ranging from 3% to 6%. However, practitioners should evaluate HRQOL in their EGID patients and consider the role it may play in HCU. Further investigation is warranted.
Mo1867 Clinical Outcomes of Rescue Treatment for Eosinophilic Esophagitis John Leung, Raman Mehrzad, Alexandra R. Alejos, Paul E. Hesterberg, Qian Yuan, Navneet Virk Hundal, Wayne G. Shreffler, Aubrey J. Katz INTRODUCTION: One third of patients with eosinophilic esophagitis (EoE) do not achieve histological remission with standard medical or dietary treatment. The outcome of these patients undergoing various rescue treatments is not known. OBJECTIVE: To analyze EoE treatment outcomes in a pediatric population, including after initial treatment failure (rescue treatment). METHODS: We identified 100 serial cases of confirmed EoE from our Redcap database established at Massachusetts General Hospital starting from January 2007. Demographic data, clinical symptoms, treatment regimens, endoscopic findings, skin testing results, food triggers and clinical outcome of various rescue treatment strategies were presented. We defined clinical response as histological remission with peak eosinophil count of at least 6 biopsies less than 10 per high power field. RESULTS: Ninety-seven EoE patients underwent initial treatments. Eighty one (84%) elected dietary treatment (7 elemental diet, 54 multiple elimination diet, and 20 single milk elimination diet) and 16 (16%) elected medical treatment (15 fluticasone and 1 budesonide). Initial response rate to dietary and medical treatment was 66% (53/80) and 56% (9/16) respectively. Of the 34 who failed initial treatment, 24 of them elected various second treatment regimens (3 medical therapy, 2 milk-free diet, 14 multiple food elimination diet and 5 elemental diet) and 50% (11/22, 2 pending results) achieved histological remission. Eight of the remaining 11 who failed second treatment underwent additional treatments and 2 ultimately achieved histological remission. The overall response rate with intention to treat increased from 65% (62/96) with initial treatment to 78% (73/94) with rescue treatment, and further to 83% (75/90) with multiple rescue treatments. CONCLUSION: Half of the patients who failed initial EoE treatment could still achieve histological remission with rescue treatments.
Mo1865 Treatment Adherence in the Eosinophilic Gastrointestinal Disorders Tiffany Taft, Laurie Keefer Introduction: Treatment adherence is a salient issue when managing chronic illness. Patients with EGIDs typically utilize dietary approaches, prescription medications, or a combination of the two. We conducted exploratory analyses to identify potential variables that may influence treatment adherence in EGID patients, including the relationships with psychological distress, health related quality of life (HRQOL), disease severity, and demographics. Methods: EGID patients were recruited online and via patient organizations. Screening questions established presence of EGID. Qualified participants completed: sociodemographic variables (age, gender, race, ethnicity, marital status, income, education, employment), symptom severity, treatment satisfaction, treatment adherence in past week, dietitian consultation, and quality of physician relationship. HRQOL was evaluated via the Eosinophilic Esophagitis Quality of Life Scale for Adults and psychological distress via the NIH-PROMIS depression and anxiety scales. Results: 139 participants completed the study: mean(SD) age was 36.9(10.1) years, 94% white, non-Hispanic, 80% female, 55% married, 64% college educated, 16% unemployed, 54% household income $50,000 or higher. Mean diagnosis duration was 3.8(3.9) years with 6.7(2.0) symptom severity rating out of 10. Patients rated the quality of relationship with their physician 7.0(3.1) and treatment satisfaction 6.4(2.8) (both out of 10). 45% had seen a dietitian for EGID. Treatment adherence (out of 100) in the past week were 81.1(29.8) for medication and 73.9(32) for diet. Modest correlations exist between diet treatment adherence and treatment satisfaction (r=.30, p=.003). Symptom
AGA Abstracts
S-676