Dilation, Eosinophils in Eosinophilic Esophagitis

In patients with eosinophilic esophagitis (EoE), eosinophil concentration was associated with symptoms in those without esophageal dilation but not in dilated patients, according to results from the Outcome Measures in Eosinophilic Gastrointestinal Disorders Across the Ages (OMEGA) study.

Researchers investigated whether dilation affects the association between eosinophil concentrations and symptoms in these patients., the Consortium of Eosinophilic Gastrointestinal Disease Researchers conducted the OMEGA study.

This prospective,  multicenter, observational study enrolled 100 patients stratified based on dilation status. Study patients completed the Eosinophilic Esophagitis Activity Index (EEsAI), a validated patient-reported outcome assessment of their symptoms, and had endoscopy during which biopsy specimens were collected.

Most of the study patients (61%) were men, and the median age of the study group was 37 years. Fifteen patients had dilation ≤1 year before the index endoscopy, and 40 had dilation >1 year before that endoscopy.

Researchers used Spearman correlations to assess the relation between patient-reported symptoms and the number of eosinophils per high-power field (HPF). They also used linear regression incorporating EEsAI measures as the outcome, eosinophils per HPF as the predictor, and an interaction for dilation and eosinophils per HPF.

Using these methods, researchers found a moderate association between number of eosinophils per HPF and symptoms in nondilated patients (rho=0.5, P < .001). They also noted an increase in the predicted EEsAI of 2.7 for every ten-eosinophil increase per HPF (P = .002) in nondilated patients.  However, these associations were not found in dilated patients.

“In conclusion, dilation modifies the association between histologic activity and symptom severity, and the effects of dilation last longer than 12 months,” researchers wrote. “In clinical practice, symptoms should not be used to monitor response to medical treatments in patients dilated within at least 12 months of index endoscopy, if not longer.”

—Ellen Kurek

Reference:

Safroneeva E, Pan Z, King E, et al. Long-lasting dissociation of esophageal eosinophilia and symptoms following dilation in adults with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2021;20(4):P766-775.E4. doi:10.1016/j.cgh.2021.05.04