Sex-related differences in the presentation, management and response to treatment of eosinophilic esophagitis: Cross sectional analysis of EoE CONNECT registry.
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Laserna-Mendieta Emilio J, Casabona-Francés Sergio, Amorena Edurne, Savarino Edoardo V, Pérez-Martínez Isabel, Blas-Jhon Leonardo, Guardiola-Arévalo Antonio, Coletta Marina, Pellegatta Gaia, Guagnozzi Danila, Barrio Jesús, Perello Antonia, Betoré Elena, Krarup Anne Lund, Votto Martina, Gutiérrez-Junquera Carolina, Naves Juan Enrique, Oliva Salvatore, Teruel Sánchez-Vegazo Carlos, Carrión Silvia, Riva Susana de la, Espina-Cadenas Silvia, Fernández-Fernández Sonia, Llorente-Barrio Mónica, Pascual-Lopez Irene, Masiques-Mas María Luisa, Honrubia-López Raúl, Dainese Raffaella, García-Morales Natalia, Cobian Julyssa, Bisso-Zein Juan Khaled, Roales Valentín, Juan-Juan Alba, Rodríguez-Sánchez Alba, Feo-Ortega Sara, Martín-Domínguez Verónica, Nantes-Castillejo Óscar, Nicolay-Maneru Julia, Ghisa Matteo, Maniero Daria, Suarez Adolfo, Maray Iván, Álvarez-García Marta, Granja-Navacerrada Alicia, Penagini Roberto, Racca Francesca, Llerena-Castro Ronald, Santander Cecilio, Arias Ángel, Lucendo Alfredo J, EUREOS and EoE CONNECT research group
Аннотация
OBJECTIVE: To investigate associations between sex and clinical presentation, endoscopic features, treatment choice and response in EoE patients in real-world practice.
METHODS: Cross-sectional analysis of the multicenter EoE CONNECT registry. The independent contribution of patients' sex and other relevant variables were statistically assessed by multivariate models.
RESULTS: A total of 2976 patients (76% male) were evaluated. Males were diagnosed at a younger age compared to females (32.7 ± 14.8 vs. 34.8 ± 15.6 years, respectively; p = 0.002) with similar diagnostic delay. EoE symptoms varied significantly between sexes, with food impaction predominating in males and dysphagia, heartburn, regurgitation and abdominal and epigastric pain in females. However, female sex contributed to higher symptom severity at diagnosis as measured with Dysphagia Symptom Score (R2 = 0.57; p = 0.013) and presented higher peak eosinophil count in esophageal biopsies (p = 0.005). Males showed increased risk of stricturing or mixed phenotypes (adjusted OR 1.43, 95%CI:1.05-1.96; p = 0.024). No association was found between patients' sex and first-line treatment modality: proton pump inhibitors (PPI) were preferred over topical corticosteroids in patients with inflammatory phenotypes instead of stricturing or mixed phenotypes, and in patients who did not present food impaction. Both topical corticosteroids and dietary interventions were preferred over PPI in pediatric patients regardless of sex.
CONCLUSIONS: Sex is associated with clinical and phenotypical presentation of EoE at diagnosis, with more fibrotic findings in males but higher symptom score in females.