Anxiety, hypervigilance, adaptive behaviours modify link between dysphagia perception, HDA in EoE

Higher esophageal anxiety, use of adaptive behaviours, and hypervigilance are common among patients with active eosinophilic esophagitis (EoE), representing clinical markers of histological disease activity (HDA), a study has found.

Ninety-five patients participated in this study. Nearly 50 percent of patients with EoE were noted to have esophageal anxiety, hypervigilance, and use of adaptive behaviours.

Histologically active EoE demonstrated significantly higher esophageal anxiety and hypervigilance (p=0.03 for both), as well as significantly more prevalent adaptive behaviours, than EoE in remission (76.8 percent vs 25.6 percent; p<0.001).

The modified dysphagia symptom questionnaire (mDSQ) and Dysphagia Symptom Score (DSS), as a standalone measurement, had an area under the receiver operating characteristic curve (AUROC) of 77.7 percent and 75.3 percent, respectively, for the prediction of HDA.

Adjustments of mDSQ and DSS based on individual Esophageal Hypervigilance and Anxiety Scale (EHAS) scores and adaptive behaviours at mealtime led to significant improvements in AUROC (86.6 percent for mDSQ and 84.3 percent for DSS; p<0.05 for both).

“Adaptive behaviours provide complementary clinical information that is not detected by symptoms alone,” the researchers said. “The assessment of adaptive behaviours, anxiety, and hypervigilance improves the correlation between clinical and HDA in EoE.”

This prospective study on adults with EoE assessed anxiety, dysphagia, and hypervigilance used specific questionnaires (ie, mDSQ, DAA, and EHAS). The research team evaluated adaptive behaviours using the Pisa EoE Adaptation Questionnaire. They also explored the relationship between dysphagia, anxiety, hypervigilance, adaptive behaviours, and HDA using appropriate statistics.