Eosinophilic esophagitis (EoE), which often affects young women of reproductive age, appears to have no negative effects on pregnancy outcomes, according to the results of a new study published in Clinical Gastroenterology and Hepatology
Little is known about the effects of EoE during pregnancy. Investigators used a survey to assess the course of EoE during pregnancy, outcomes of pregnancies, and patient concerns related to pregnancy and EOE in all female patients treated at 2 EoE centers in Switzerland.
Of 151 female patients treated at the centers, 72 returned the survey, for a response rate of 47.7%. Of the respondents, 20 patients had at least 1 pregnancy; in total, data from 34 pregnancies were analyzed.
During pregnancy, 55.9% (19/34) of respondents reported improvement of dysphagia; however, deterioration occurred during 20.1% (7/34) of pregnancies. A majority of respondents who reported improved or deteriorated symptoms during pregnancy, 68.4% (13/19) and 57.1% (4/7), respectively, had their level of dysphagia return to the prepregnancy state after pregnancy.
Esophagogastroduodenoscopy was conducted during 8.8% (3/34) of pregnancies. Two patients had bolus impactions and 1 patient developed herpes simplex esophagitis. Pregnancy-related complications, including 1 miscarriage, occurred during 11.8% (4/34) of pregnancies.
Regarding concerns about pregnancy and EoE, 50% of patients report no concerns. The most common patient-reported concerns were fear of heritability (40.0%, 8/20) and fear of medication harming the fetus (30.0%, 6/20).
Limitations of the study included the small sample size and its retrospective nature. The authors also indicated that the survey was a nonvalidated tool, and patient ages at time of pregnancy were not collected.
“Despite the low number, our study represents the largest number of pregnant EoE patients ever examined,” wrote the authors.
The authors concluded by making 4 clinical suggestions:
1. Female patients with EoE considering pregnancy should be informed that to date, no increased maternal and fetal risk was observed in pregnant patients with EoE on and off EoE-specific medication.
2. In patients having inactive disease at the beginning of a pregnancy, a cessation of the treatment may be considered, provided that the patients undergo regular monitoring of EoE during pregnancy.
3. In patients with active disease at the beginning of the pregnancy, the treatment should be continued.
4. After delivery, patients having had an improvement in symptoms during pregnancy must be advised to pay attention to a worsening of symptoms.
Schreiner P, Meissgeier S, Safroneeva E, et al. Disease progression and outcomes of pregnancies in women with eosinophilic esophagitis [published online December 5, 2019]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2019.11.057