Impact of Eosinophilic Esophagitis on Quality of Life Is Not Negligible

Individuals with eosinophilic esophagitis (EoE) experience a health-related decline in quality of life that is comparable to the impact of other immune-mediated conditions such as inflammatory bowel disease (IBD) and systemic lupus erythematosus, according to an analysis presented at Digestive Disease Week 2024.

EoE is a chronic, progressive disease associated with dysphagia and eosinophilic infiltration of the esophageal mucosa, which can have a negative impact on patients’ quality of life. However, the effects of EoE on everyday functioning and its impact on work- and social-related activities has not drawn as much attention as those associated with IBD. “The extent of inflammatory organ involvement in eosinophilic esophagitis is relatively limited compared to other immune-mediated diseases,” the authors wrote. “This might translate into the premature assumption that EoE exerts only a limited impairment of quality of life.”

The team of researchers led by Luc Biedermann, MD, a senior attending physician in the Department of Gastroenterology and Hepatology at Universitats Spital, in Zurich, Switzerland, set out to study the effects of EoE beyond esophageal inflammation. Patients with different immune-mediated diseases were asked to fill in a questionnaire that was designed to assess baseline characteristics, general quality of life, and disease-related impairment in several subdomains, including work, leisure, and social life. Of 608 Swiss patients who responded to the anonymous survey sent out by their patient organizations, 92 had EoE, 407 had IBD, 69 had systemic sclerosis, and 40 had lupus.

While patients with Crohn’s disease, systemic sclerosis, and lupus had the most perceived general impairment in everyday life, those with EoE reported a similar decline in quality of life to those with ulcerative colitis and to patients with IBD overall. Moreover, individuals with EoE reported the highest impairment in leisure-related activities. Women with EoE were affected disproportionately, reporting a higher perceived disease-related impairment both overall and across the different subdomains. The authors were surprised to find that perceived general impairment was higher in women with EoE than in men with ulcerative colitis, Biedermann noted.

A delay in diagnosis also seemed to make a difference in terms of quality of life. Patients who had a diagnostic delay of at least 10 years after the first occurrence of symptoms reported a significantly higher impairment in everyday life as well as in leisure-, social-, and travel-related activities than those who received a diagnosis of EoE within 10 years of symptom onset.

Overall, nearly half of individuals with EoE said they thought about their disease daily, suggesting that the psychosocial impact of EoE may be profound. “Patients' perceived general impairment in everyday life is substantial and not different to ulcerative colitis and IBD,” the authors concluded. “Specifically, leisure-related impairment is distinctively high in EoE and in line with the other investigated systemic immune-mediated disease states.”