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While time may result in distal esophageal wall thickness in patients with eosinophilic esophagitis (EoE), new research suggest this occurs independent of dysphagia score and eosinophil count.¹

A team, led by Stephanie Wong, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, longitudinally assessed the endoscopic appearance, wall thickness, histology, and dysphagia score for patients with EoE.

A Disease Not Fully Understood

“The natural history of EoE is incompletely understood, and it is yet unclear as to whether phenotypic variations exist or if these differences indicate a different disease pattern of responsiveness to therapy or prognosis,” the authors wrote. “Current data indicate that EoE is a chronic, progressive disease with persistence of dysphagia and long-term complications such as stricture formation, food impaction, narrow-caliber esophagus, and esophageal perforation.”

However, EoE can progress to a fibro-stenotic phenotype because of esophageal sub-epithelial fibrosis. There have been a few studies recently using endoscopic ultrasound to show esophageal wall thickening in patients with EoE.

The Patients

In the study the Royal Adelaide Hospital, the investigators examined 16 patients with EoE between February 2012 and April 2021 with a mean follow-up of 2.2 ± 1.2 years. Each participant was evaluated twice at least 12 months apart with endoscopy, endoscopic ultrasound, and esophageal mucosal biopsies. The investigators assessed dysphagia scores and epidemiology data.

The participants were identified through a pre-existing database and enrolled at their outpatient clinic with endoscopy appointments, or through an invitation letter.

Each participant assessed was between 18-70 years at the time of the diagnosis of EoE, defined as at least 15 eosinophils/high powered field of symptoms of esophageal dysfunction and exclusion of other causes of esophageal eosinophilia. The mean age at the initial assessment was 43.5 years.

The team measured esophageal wall thickness in a contracted state to avoid distortion caused by longitudinal furrows and ensure constant distensibility of the esophagus.

Results

The results show 88% (n = 14) of patients had total wall thickness of the distal esophagus that significantly increased (P = 0.0012) as a result of thickening of the muscularis propria (P = 0.0218).

On the other hand, only 7% (n = 1) of patients had an increase in dysphagia scores, comap4red to 57% (n = 8) who had a stable score and 36% (n = 5) that had a reduced dysphagia score.

The investigators did not find differences in the total thickness of other esophageal regions, dysphagia score, endoscopic appearance, and eosinophil count over time.

“Distal esophageal wall thickness increases with time in EoE patients, independent of the dysphagia score and eosinophil count,” the authors wrote.

References:

Wong, S., Safaeian, R., Zobel, J., Holloway, R. H., Ruszkiewicz, A., & Nguyen, N. Q. (2023). Increase in distal esophageal wall thickness with time in adult patients with eosinophilic esophagitis. JGH Open. https://doi.org/10.1002/jgh3.12866