{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T12:42:20Z","timestamp":1787402540885,"version":"build-2736575974"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,7]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Eosinophilic Esophagitis (EoE) is a chronic inflammatory esophageal disorder, often associated with dysphagia, chest discomfort, and heartburn. There is limited information on persistent esophageal symptoms despite histologic remission (HR). We aimed to assess the prevalence and predictors of persistent esophageal symptoms in adult patients with EoE in HR. We performed a retrospective cohort study of adult EoE patients in HR (&amp;lt;15 eosinophils per high power field [eos\/hpf]). Exclusion criteria included: no available data on symptoms, chronic opiate use, disorders of esophagogastric junction outflow on Chicago Classification version 4 diagnosis, esophageal candidiasis, erosive esophagitis, or other known cause of esophageal dysphagia besides EoE. Based on prior literature, definitions include: complete HR (&amp;lt;5 eos\/hpf), partial HR (5\u201314 eos\/hpf), and endoscopic fibrostenosis (rings and\/or stricture). Esophageal symptoms were assessed within 2\u00a0weeks of HR and categorized into the major symptoms of dysphagia, chest pain, and heartburn. Given the retrospective nature of the study, a global symptom response (absence or presence) was used. Demographics, disease history, endoscopy reports, EoE endoscopic reference score, and histology were recorded. Univariate and multivariable logistic regression analyses were performed. Eosinophil thresholds for persistent symptoms were determined using receiver operating characteristics analyses. Of 289 EoE patients in HR, 133 (46%) had esophageal symptoms: dysphagia (N\u2009=\u2009119; 41.2%), heartburn (N\u2009=\u200928; 20.8%), and chest pain (N\u2009=\u200910; 7.5%). Significant predictors for persistent dysphagia were anxiety (adjusted odds ratio [aOR] 3.77) and endoscopic fibrostenosis (aOR 3.87). Significant predictors for persistent heartburn with or without chest pain were anxiety or depression (aOR 12.2 and aOR 11.0) and partial HR (aOR 1.17 and aOR 1.18). Threshold eosinophil counts for persistent heartburn and chest pain were 2.5 and 3.5 eos\/hpf, respectively (AUC 0.71 and 0.69). We report a high prevalence of persistent esophageal symptoms in EoE patients who are in HR. Risk factors include anxiety, depression, endoscopic fibrostenosis, and partial HR. These findings can help direct patient care, including endoscopic dilation and managing psychiatric comorbidities. Targeting less than 2.5 and 3.5 eos\/hpf for heartburn and chest pain may be warranted.<\/jats:p>","DOI":"10.1093\/dote\/doae110","type":"journal-article","created":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T10:30:58Z","timestamp":1734172258000},"source":"Crossref","is-referenced-by-count":8,"title":["Predictors of persistent symptoms in eosinophilic esophagitis after remission: fibrostenosis, eosinophilia, anxiety, and depression"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7611-5767","authenticated-orcid":false,"given":"Claire A","family":"Beveridge","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Hermanns","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Community Care Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1835-1381","authenticated-orcid":false,"given":"Shivani","family":"Thanawala","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, University of Pennsylvania , Philadelphia, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Community Care Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center , San Antonio, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naga Venkata Rama Kirshna","family":"Vura","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center , San Antonio, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qijun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashanthi","family":"Thota","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Hoscheit","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Mark","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]},{"name":"Center for Microbiome and Human Health, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei I","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Lembo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Gabbard","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Rieder","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic , Cleveland, OH ,","place":["USA"]},{"name":"Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, OH 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