Esophageal Distensibility Predicts Fibrostenotic Severity in Pediatric EoE

Study findings support the use of distensibility as a metric of disease severity in children with eosinophilic esophagitis.

An esophageal distensibility index (DI) of less than 4.5 mm2/mm Hg is a useful threshold for predicting fibrostenotic severity in children with eosinophilic esophagitis (EoE), according to study findings published in Clinical Gastroenterology & Hepatology.

Researchers sought to assess the associations between esophageal distensibility and the histologic, endoscopic, and clinical parameters of disease severity. They conducted a study that comprised 59 children with EoE (age range 9-21 years; median age 15 years; 81% boys; 85% White) who were prospectively recruited at Ann & Robert H. Lurie Children’s Hospital of Chicago. All of the participants were undergoing upper endoscopy and endoscopic functional lumen imaging probe (EndoFLIP).

The DI and esophageal diameter were used to evaluate esophageal distensibility at the distensibility plateau (DP). Chi-squared tests were used to compare categorical variables, and continuous variables were compared using Mann-Whitney U/Kruskal-Wallis tests. To determine the usefulness of distensibility as a method of defining esophageal rigidity, receiver operating characteristic analysis was used.

Participants who had fibrostenotic features confirmed via endoscopy had a significantly lower DI than those with inflammatory symptoms (3.7±1.8 vs 5.1±1.5, respectively; P =.02) or normal (3.7±1.8 vs 6.6±1.8, respectively; P =.0003) features. No association was observed between fibrostenotic features and eosinophil count. A DI of less than 4.5 mm2/mm Hg significantly predicted grade 2 rings with endoscopy (area under the curve 0.81; P =.004). DI significantly predicted food impaction with and without adjustments (fully adjusted odds ratio [OR] 1.44; 95% CI, 1.03-2.10; P =.04).

Limitations to this study include potential selection bias due to a small cohort, a lack of controls, and limited symptom data.

The study authors conclude, “DI at the DP is associated with endoscopic ring severity and clinical history of food impaction regardless of age, height, or active inflammation.” Specifically, they add, “[W]e establish DI <4.5 mm2/mmHg as a predictor of grade 2 rings, and therefore fibrostenotic severity (fully adjusted model with OR 3.96, 95% CI, 2.05-10.52, P =0.0007), and <2 mm2/mm Hg as an absolute cutoff.”

References:

Hoffmann NV, Keeley K, Wechsler JB. Esophageal distensibility defines fibrostenotic severity in pediatric eosinophilic esophagitis. Clin Gastroenterol Hepatol. Published online September 13, 2022. doi: 10.1016/j.cgh.2022.08.044