Histologic response is associated with improved esophageal distensibility and symptom burden in pediatric eosinophilic esophagitis.

Background And Aims: 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. We aimed to evaluate the relationship between esophageal distensibility, histology, and fibrostenotic complications in a cohort of children with EoE.

Methods: We conducted a prospective longitudinal study at two tertiary pediatric institutions to evaluate longitudinal changes in esophageal distensibility in pediatric subjects aged 3 to 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.

Results: Three hundred endoscopies involving 112 EoE patients (mean age 12.8 years, 72.3% 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/year, p = 0.003). After adjusting for EREFS and age of symptom onset, lower esophageal distensibility was independently associated with increased odds of patient-reported dysphagia (OR 0.85, CI 0.75-0.96, p = 0.008). Patients who developed clinical features of fibrostenosis were older at diagnosis (9.9 vs 6.7 years, p = 0.032), experienced longer disease duration (4.4 vs 2.4 years, p = 0.046), and had lower baseline esophageal distensibility (13.0 vs 14.9 mm, p = 0.012). Baseline distensibility predicted the need for future stricture dilation (AUC 0.757, p = 0.0003).

Conclusion: Histologic remission is associated with improved esophageal distensibility over time in pediatric EoE patients. Baseline esophageal distensibility provides a quantitative marker of tissue remodeling and may help predict disease severity and fibrostenotic progression.