Controlling Inflammation Improves Outcomes in Pediatric EoE

Research study background

In individuals with eosinophilic esophagitis (EoE), persistent inflammation doesn’t just cause discomfort; it can change the structure of the esophagus and impair its function over time. When it occurs, extensive esophageal narrowing can cause worsening symptoms such as dysphagia, forcing patients to undergo repeated endoscopic dilations.

Emerging evidence suggests that controlling inflammation in EoE may reverse tissue damage and increase esophageal diameter in adults. However, the impact of sustained histologic control during childhood on altering disease course is not known. This prospective study, which assessed esophageal distensibility, histology and clinical outcomes over time, is the first to address this gap in pediatric EoE. As part of an ongoing research collaboration between EoE experts in the Digestive Health Institute at Children’s Hospital Colorado and the Children’s Hospital of Philadelphia, investigators monitored 112 patients with EoE, ages 3 to 18, through 300 endoscopies over time.

During each endoscopy, functional lumen imaging probe (FLIP) technology was used to measure esophageal diameter and assess distensibility. The team was first to validate FLIP as a reliable, safe tool for use in children with EoE in an earlier study. The study also collected esophageal biopsies to evaluate histology and categorized patients into four groups (continuous remission, continuous inflammation, resolved inflammation, or variable inflammation). Study authors scored endoscopic features such as rings and strictures to define fibrostenosis. Patients were also assessed for symptoms over the preceding month.

The analysis revealed several important findings. Children who achieved histologic remission showed measurable improvements in esophageal distensibility, while those with persistent inflammation had minimal gains. The greatest improvements occurred in patients with active disease at baseline who later achieved remission. This suggests that effective treatment can partially reverse early tissue remodeling. Lower baseline distensibility was independently associated with dysphagia and predicted the need for future esophageal dilation. Patients who developed fibrostenosis during follow-up also had significantly lower baseline distensibility.

FLIP technology proved especially valuable by detecting narrowing before strictures were visible on endoscopy. This functional measure complements traditional endoscopy and histology, providing a sensitive tool to assess disease progression and EoE treatment response.

“Baseline esophageal distensibility provides a quantitative marker of tissue remodeling and may help predict disease severity,” says Calies Menard-Katcher, MD, pediatric gastroenterologist. “Our results strengthen the argument for why it is important to treat inflammation.”

Clinical implications

The study authors noted that future research could include a larger cohort and combine molecular studies with new advances in FLIP analysis. This may further improve how clinicians identify patients with EoE who are at the greatest risk of severe disease and complications.