All ETDs from UAB

Advisory Committee Chair

Burel R Goodin

Advisory Committee Members

Margaux J Barnes

Reed A Dimmitt

Aaron Fobian

David C Schwebel

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

EoE is a chronic, clinico-pathological, esophageal disease with symptoms that include dysphagia, reflux, vomiting, feeding aversion, and epigastric pain. Diagnosis requires clinical symptom presentation and histologic findings of eosinophil-predominant inflammation of the esophagus. While the pediatric patient’s epigastric pain is predictive of their quality of life, little is known about their pain experience. Through two studies, the pain experience, sleep quality, and internalizing symptoms of youth with Eosinophilic Esophagitis (EoE) have been examined. Through individually evaluating each of these factors as well as testing their relations with each other, the model proposed by Lynch and colleagues (2015) to understand the impact of EoE on quality of life has been assessed. With the use of two studies, the pain experience of youth with EoE has been compared to other pediatric gastrointestinal populations, the emotional functioning of youth with EoE, their caregivers, and that of other gastrointestinal populations has been examined, and the objective and subjective sleep quality of youth with EoE has been compared to their healthy peers. The pain experience and pain interference of youth with EoE and persistent epigastric pain (EoE-P) was most similar to that of Recurrent Abdominal Pain (RAP). The level of internalizing symptoms for youth with EoE was similar to that of both youth with RAP and Gastroesophageal Reflux Disease. Additionally, the emotional functioning and worry of caregivers was significantly correlated with the youth’s internalizing symptoms as well as their healthcare utilization. The sleep quality of youth with EoE-P was significantly worse than that of youth with EoE without pain and their healthy peers. Finally, no significant relations were found among pain, anxiety, mood, and sleep variables using microlongitudinal sleep diary reports. The knowledge gained from these studies supports a shift in the current healthcare approach in the assessment and treatment of EoE by emphasizing the pain, sleep quality and emotional functioning of pediatric patients with EoE. Additionally, treatments efficacious for RAP may be useful in improving the symptom presentation and quality of life of youth with EoE and persistent pain.

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