Histologic Response Is Associated With Improved Esophageal Distensibility and Symptom Burden in Pediatric Eosinophilic Esophagitis.

Abstract

Chronic eosinophilic esophagitis (EoE)-associated inflammation can lead to progressive tissue remodeling and fibrostenosis. Longitudinal studies are limited, and the impact of histologic disease control during childhood remains unknown. The aim of this study was to evaluate the relationship between esophageal distensibility, histology, and fibrostenotic complications in a cohort of children with EoE. We conducted a prospective longitudinal study at 2 tertiary pediatric institutions to evaluate longitudinal changes in esophageal distensibility in pediatric patients aged 3-18 years. Impedance planimetry was used to determine esophageal distensibility during the baseline endoscopy and all subsequent clinically necessary endoscopies. Symptomatic, endoscopic, and histologic data were collected at each visit. Three hundred endoscopies involving 112 patients with EoE (mean age, 12.8 years, 72.3% were male) were included, with a median follow-up time of 11 months (range, 2-54 months). Participants exhibiting a histologic response to treatment showed the most significant improvement in distensibility over time (1.41 vs 0.16-0.53 mm/y; P = .003). After adjusting for Eosinophilic Esophagitis Endoscopic Reference Score and age at symptom onset, lower esophageal distensibility was independently associated with increased odds of patient-reported dysphagia (odds ratio, 0.85; 95% CI, 0.75-0.96; P = .008). Patients who developed clinical features of fibrostenosis were older at diagnosis (9.9 vs 6.7 years; P = .032), experienced longer disease duration (4.4 vs 2.4 years; P = .046), and had lower baseline esophageal distensibility (13.0 vs 14.9 mm; P = .012). Baseline distensibility predicted the need for future stricture dilation (area under the curve, 0.757; P = .0003). Histologic remission is associated with improved esophageal distensibility over time in pediatric patients with EoE. Baseline esophageal distensibility provides a quantitative marker of tissue remodeling and may help predict disease severity and fibrostenotic progression.