Study of the Week: Eosinophilic Esophagitis Appears to Increase Rates of Psychiatric Illness

Welcome to Study of the Week from Patient Worthy. In this segment, we select a study we posted about from the previous week that we think is of particular interest or importance and go more in-depth. In this story we will talk about the details of the study and explain why it’s important, who will be impacted, and more.

If you read our short form research stories and find yourself wanting to learn more, you’ve come to the right place.

 

This week’s study is…

Individuals with eosinophilic esophagitis are at greater risk of later psychiatric disorder

We previously published about this research in a story titled “Study: Eosinophilic Esophagitis Patients at Greater Risk for Psychiatric Illness” which can be found here. This study was first published in the scientific journal The American Journal of Gastroenterology. You can view the abstract of the study here.

This study was affiliated with the Örebro University Hospital in Sweden.

What Happened?

In the past, studies have been conducted about possible relationships between eosinophilic esophagitis and mental health conditions such as anxiety or depression. The results, however, have been indecisive. A team of scientists aimed to shed further light on the situation in this study. The team drew upon data from the Swedish ESPRESSO cohort, a database of 6 million gastrointestinal biopsy samples.

From this collection they found 1,458 people who were eosinophilic esophagitis patients. They had not reported experiencing psychiatric illness before their diagnosis with the disease. 58 percent experienced food impaction and 70 percent had dysphagia (difficulty swallowing). As a control sample, five unaffected people from Swedish population register were matched with each patient by age, county, sex, and year of diagnosis.

The researchers found a total of a psychiatric illness incidence rate of 10.93 per 1000 person-years in unaffected people. In people with eosinophilic esophagitis, the incidence rate was 15.96 per 1000 person-years. This indicates roughly a 50 percent increase in psychiatric illness risk among patients. The team then sought to adjust for other possible factors, such as genes and environment, by comparing the incidence rate of 1,055 patients to that of 1,699 siblings of the patients that did not have the disease.

74 instances of psychiatric illness were reported among the siblings. When compared to the incidence rate found in patients, this suggests an increased risk of 62 percent. The team found no difference in risk by educational attainment or with the use of proton-pump inhibitors or steroids. The increased risk was also still present even after accounting for other conditions, such as asthma, celiac disease, and inflammatory bowel disease.

About Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE), is a condition in which the esophagus becomes inflamed due to an allergic reaction that involves the activity of eosinophils, a form of white blood cell. Generally, the allergic reaction is triggered by some type of food that the patient has eaten, but it is often difficult to determine which specific food item is the cause. Symptoms of eosinophilic esophagitis include difficulty swallowing, nausea, painful swallowing, heartburn, rings in the esophagus, narrowing of the esophagus, blockage of the esophagus, and vomiting. Current treatments involve medication to suppress the immune response, eliminating known food allergens, and expanding the esophagus. Many people with the condition also have other autoimmune problems, such as celiac disease or asthma. To learn more about eosinophilic esophagitis, click here.

Why Does it Matter?

Understanding that eosinophilic esophagitis is associated with an increased incidence of psychiatric illness is of vital importance so that physicians can understand that there is a need to screen their patients for these conditions and treat them in a timely and appropriate manner. Other studies have found a similar connection in celiac disease and inflammatory bowel disease.

The researchers speculate that higher rates of psychiatric illness could be the result of both symptoms and treatments, which could lead to chronic pain and stress. These could in turn lead to challenges at work, education, or in social contexts. Questionnaires can be used in order to help identify psychiatric conditions such as ADHD, which can then be treated by an appropriate specialist.

“We’ve found that symptom-specific anxiety is prevalent and associated with other outcomes, like quality of life, so it may not be the typical anxiety that you would diagnose from the Diagnostic and Statistical Manual of Mental Disorders,” says Tiffany Taft, PsyD, a research associate professor of medicine at Northwestern University in Chicago.

Anxiety can make the symptoms of eosinophilic esophagitis worse, so educating patients about the possible connection between their anxiety and their disease can be vital and can help patients manage more effectively.

In more serious cases, medications and cognitive behavioral therapy (CBT) may be needed.

“We also add in relaxation, deep breathing, and guided imagery to calm down the stress response in the body, which is part of that brain-gut connection that enhances symptom severity.” – Tiffany Taft, PsyD

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