Eosinophilic esophagitis (EoE) is a chronic disease.[160]Straumann A, Spichtin HP, Grize L, et al. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology. 2003 Dec;125(6):1660-9.
http://www.gastrojournal.org/article/S0016-5085(03)01515-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/14724818?tool=bestpractice.com
However, the prognosis is good. The majority of patients have a good response to either pharmacologic or dietary elimination therapy. If strictures or esophageal narrowing develop, these can be effectively treated with esophageal dilation.
Approximately one third of patients may be refractory to standard treatments and these patients can be very difficult to treat; often they are referred to clinical trials.[28]Dellon ES, Liacouras CA. Advances in clinical management of eosinophilic esophagitis. Gastroenterology. 2014 Dec;147(6):1238-54.
https://www.gastrojournal.org/article/S0016-5085(14)00980-9/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/25109885?tool=bestpractice.com
Studies show that symptoms usually recur when treatment is stopped.[3]Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013 May;108(5):679-92.
http://www.ncbi.nlm.nih.gov/pubmed/23567357?tool=bestpractice.com
Natural history
The natural history of EoE suggests that, in some patients, chronic eosinophilic inflammation can lead to fibrostenotic remodeling.[5]Lipka S, Kumar A, Richter JE. Impact of diagnostic delay and other risk factors on eosinophilic esophagitis phenotype and esophageal diameter. J Clin Gastroenterol. 2016 Feb;50(2):134-40.
http://www.ncbi.nlm.nih.gov/pubmed/25710524?tool=bestpractice.com
[6]Schoepfer AM, Safroneeva E, Bussmann C, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology. 2013 Dec;145(6):1230-6.
http://www.gastrojournal.org/article/S0016-5085(13)01161-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23954315?tool=bestpractice.com
[7]Dellon ES, Kim HP, Sperry SL, et al. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc. 2014 Apr;79(4):577-85.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599711
http://www.ncbi.nlm.nih.gov/pubmed/24275329?tool=bestpractice.com
[35]Dellon ES, Gibbs WB, Fritchie KJ, et al. Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2009 Dec;7(12):1305-13.
https://www.cghjournal.org/article/S1542-3565(09)00834-9/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/19733260?tool=bestpractice.com
[176]Kim HP, Vance RB, Shaheen NJ, et al. The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol. 2012 Sep;10(9):988-96.
https://www.cghjournal.org/article/S1542-3565(12)00526-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/22610003?tool=bestpractice.com
[177]Noel RJ, Putnam PE, Collins MH, et al. Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2004 Jul;2(7):568-75.
http://www.ncbi.nlm.nih.gov/pubmed/15224281?tool=bestpractice.com
Data show that the longer symptoms are present before diagnosis and treatment the more common it is to have esophageal strictures and signs of remodeling.
To date, there has been no association of EoE with esophageal cancer, and no cases of EoE have devolved to a more diffuse eosinophilic gastroenteritis or to hypereosinophilic syndrome.