Coping Strategies Related to Perception of Health-Related Quality of Life in EoE

Less-effective coping strategies, such as passive and palliative reaction, were associated with a significant impact on health-related quality of life in eosinophilic esophagitis (EoE).

Among adult patients with eosinophilic esophagitis (EoE), less effective coping strategies are related to a worse perception of health-related quality of life (HRQOL).

Researchers from Amsterdam University Medical Center in Amsterdam, The Netherlands, evaluated the use of coping strategies and the relation to HRQOL. The findings were published in Journal of Neurogastroenterology and Motility.

EoE is a chronic disease of the esophagus that is triggered by a high number of eosinophils brought on by type 2 inflammation. There is a strong connection between food allergies and EoE, and some foods may trigger a reaction.

Medical therapy and dietary elimination are the first-line management of EoE, and most patients adapt their eating behaviors and avoid eating in daily social life, which can cause social situations to be stressful and embarrassing.

The researchers had patients complete the Short Form-36 Health Survey (SF-36) to understand general HRQOL and the Utrechtse Coping Lijst (UCL) to evaluation coping strategies. SF-36 scores were compared with a random sample of 1742 individuals in the Dutch population.

“Coping refers to emotional, cognitive, and behavioral efforts that affects the way each individual handles the physical, social, and mental burden that is linked to stressful life events, such as having a chronic illness,” they explained.

A total of 147 patients with EoE completed the questionnaires, with 61% of respondents being male and the median age being 43 years. The median age at diagnosis was 39 years and patients reported that the median time between when EoE symptoms were firs reported and a diagnosis of EoE was 5 years.

Most patients reported ongoing. Symptoms of dysphagia and/or food impacting (66%) or having to adapt their eating as a result of their EoE (64%).

The Physical Health Component Scores (PCS) of SF-36 for the patients with EoE was similar to the general population. However, while the male patients with EoE were not significantly different from males in the general population, female patients with EoE scored significantly lower than females in the general population. Female patients with EoE also scored significantly lower than the males with EoE.

The Mental Health Component Score (MCS) of the SF-36 were significantly lower for patients with EoE compared with the general population. In the reverse from the PCS, female patients had similar scores to the general population, while males scored significantly lower.

Females had a significantly lower score for how the disease impacted psychosocial functioning. The subdomains with the lowest scores were disease anxiety and eating/diet impact, and females had lower levels on both compared with males.

On the UCL, 7 domains were evaluated:

  • Active problem solving—overlooking the situation, being focused on the problem and privately solving the situation
  • Palliative reaction—Not having to deal with a problem by looking for distraction
  • Avoidance and passive expectancy—Avoiding difficult situations and attending to an issue as little as possible
  • Seeking social support—Discussing the problem with friends and family or getting someone to help
  • Passive reaction—Having a negative reaction to the problem and withdrawing or becoming overwhelmed and incapable of activity
  • Expression of emotion and anger—Showing emotions as anger or fear
  • Reassuring thoughts—Keeping a positive attitude toward the problem or putting it into perspective

However, patients with EoE were significantly better at active problem solving, palliative reaction, avoidance and passive expectancy, and seeking social support compared to the general population, according to the UCL.

Patients with EoE were significantly less likely to report passive reaction and expression of emotion and anger compared with the general population. Male patients had significantly better at active problem solving, palliative reaction, avoidance, and seeking social support compared with males in the general population. While female patients with EoE showed more palliative reaction compared with those in the general population.

In male patients with EoE, “palliative reaction, avoidance, and passive reaction significantly correlated with higher impairment of the MCS.” For female patients, a passive coping style significantly correlated with lower levels of the MCS. For both genders, active problem solving correlated with improvement of mental HRQOL.

The authors noted some limitations. While the sample of patients from an outpatient clinic of a tertiary health care center limits generalizability of the findings, the cohort included different stages of disease severity and treatment.

“This study emphasizes the importance of HRQOL being a key health outcome in daily EoE practice and research evaluation effect of interventions,” the authors concluded. “Therefore, a pro-active approach towards coping mechanisms and provision of sufficient mental care is needed to support adjustment to living with a chronic illness, and ultimately enhance EoE patients HRQOL.”