Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2022;20(4):766–75.e4
Long-lasting dissociation of esophageal eosinophilia and symptoms after dilation in adults with eosinophilic esophagitis
Background and aims: Esophageal dilation improves dysphagia but not inflammation in eosinophilic esophagitis (EoE) patients. The authors investigated if dilation modifies the association between symptoms and peak esophageal eosinophils per high-power field (eos/hpf).
Methods: Adults enrolled in a multisite prospective Consortium of Gastrointestinal Eosinophilic Disease Researchers Outcome Measures for Eosinophilic Gastrointestinal Diseases Across Ages observational study completed the symptom-based Eosinophilic Esophagitis Activity Index (EEsAI) Patient-Reported Outcome instrument and underwent endoscopy with biopsy specimens. Patients were stratified based on dilation status as absent, performed ≤ 1 year before endoscopy, and performed > 1 year before endoscopy. Assessments included Spearman correlations of the relationship between symptoms and eos/hpf and linear regression with EEsAI as the outcome, eos/hpf as predictor, and interaction for dilation and eos/hpf.
Results: Among 100 patients (n = 61 males; median age, 37 years), 15 and 40 patients underwent dilation ≤ 1 year and > 1 year before index endoscopy, respectively. In non-dilated patients, the association between eos/hpf and symptoms was moderate (ρ = 0.49; p < 0.001); for a 10-eos/hpf increase, the predicted EEsAI increased by 2.69 (p = 0.002). In patients dilated ≤ 1 year and > 1 year before index endoscopy, this association was abolished (ρ = -0.38; p = 0.157 for ≤ 1 year and ρ = 0.02; p = 0.883 for > 1 year); for a 10-eos/hpf increase, the predicted EEsAI changed by -1.64 (p = 0.183) and 0.78 (p = 0.494), respectively. Dilation modified the association between symptoms and eos/hpf (p = 0.005 and p = 0.187 for interaction terms of eos/hpf and dilation ≤ 1 year before and > 1 year before index endoscopy, respectively).
Conclusions: In non-dilated eosinophilic esophagitis (EoE) adults, esophageal eosinophils per high-power field correlate modestly with symptoms; this correlation was no longer appreciated in dilated patients, and the dilation effects lasted longer than 1 year. Dilation status should be considered in studies evaluating EoE treatment and for clinical follow-up evaluation.