Better control of childhood EoE inflammation linked to less esophageal stiffening

Researchers from Children’s Hospital of Philadelphia (CHOP) and Children’s Hospital Colorado have found that better control of chronic eosinophilic esophagitis (EoE)-associated inflammation during childhood leads to less stiffening of the esophagus, resulting in fewer disease complications. Using Endoluminal functional imaging (FLIP), the study team suggests this could be a key marker for assessing disease severity and progression. The findings were published online today by the journal Gastroenterology.

EoE is a chronic allergic inflammatory disease of the esophagus, the muscular tube that carries food from the throat to the stomach. Children can experience nausea, regurgitation, vomiting, abdominal pain and a burning feeling like acid reflux. They may also have difficulty swallowing and gag frequently. Often, they can experience dysphagia, which is when it feels like something is stuck in their throat. If EoE goes untreated, the esophagus may narrow because of scarring, a phenomenon known as stricture.

Chronic EoE-associated inflammation can lead to progressive tissue remodeling and fibrostenosis, or the narrowing of the esophagus. While clinicians recognize the severity of the disease, long-term studies looking at disease progression over time, and the impact of controlling the disease from a young age, is relatively unknown.

“This is the first study to follow kids overtime (with these endoscopic assessments) and evaluate the patients who are at the highest risk of complications,” said co-senior study author Amanda Muir, MD, a pediatric gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at CHOP. “With the recent FDA approval of two medications for EoE, having this data could help identify the patients who could benefit from these therapies the most and observe improvement at a histologic level over time.”

Researchers at CHOP and Children’s Hospital Colorado launched a longitudinal study to evaluate long-term changes in esophageal distensibility, or the ability of the esophagus to expand, in pediatric patients between the ages of 3 and 18 years old. Symptomatic, endoscopic and histologic data were collected at each visit during the study. A total of 112 patients with EoE were included with a median follow-up time of 11 months, some followed for over 4 years.

“Following children living with EoE over time has given us a clearer picture of how inflammation affects the esophagus and how treating it can improve the esophagus and outcomes for patients,” said Calies Menard-Katcher, MD, co-senior study author and Associate Director of Clinical Research for the Gastrointestinal Eosinophilic Diseases Program at Children’s Hospital Colorado. “It’s exciting to see these results confirm what we’ve suspected in caring for patients — and they may even help us spot those at risk for more severe disease.”

The study found that patients with tissue samples showing a response to treatment demonstrated the most improvement in distensibility over time. After adjusting for different factors, the study found that patients with lower esophageal distensibility had increased odds of patient-reported dysphagia, or difficulty swallowing. Patients with fibrostenosis were generally diagnosed at an older age, had the disease for a longer period and showed reduced esophageal flexibility.

Measuring distensibility at baseline predicted the need for future dilation in patients with strictures.

The authors suggest that further studies that examine the disease from a molecular level could help them understand which patients may be at highest risk of severe disease and could benefit from a variety of treatment strategies.