Researchers Use GI Device to Target Early Esophageal Scarring in Pediatric EoE

A recent study using a currently approved FDA gastrointestinal (GI) device showed it could also be used to clarify the level of early scarring in the esophagus of pediatric patients with eosinophilic esophagitis (EoE).

The Endoscopic Functional Luminal Impedance Probe (EndoFLIP) measures simultaneous pressure and diameter to diagnose and manage various upper gastrointestinal disorders. The distensibility index (DI) is a functional measure of how much force (mm²/mm Hg) is required to stretch open the esophagus.

Writing in Clinical Gastroenterology and Hepatology, researchers in Chicago said that previously, the extent of scar tissue in the esophagus could only be evaluated visually during endoscopy, making it challenging to detect early scarring and intervene before the damage progresses, leading to the development of esophageal rings and stricture, which can cause solid food to become impacted.

Symptoms of fibrostenosis, a complication of chronic EoE, are highly variable and may contribute to esophageal dysfunction even if the early stages are undetected on endoscopy.

The researchers analyzed a prospectively recruited group of 59 patients aged 9 to 21 years undergoing upper endoscopy and EndoFLIP for suspected or previously diagnosed EoE in order to assess whether esophageal DI can be used to define fibrostenotic severity. The DI is not affected by age in children older than 9 years, they noted.

“In pediatric EoE, the usefulness of esophageal distensibility as a clinical phenotyping tool remains unclear,” they wrote. “Further, it is unknown how esophageal distensibility in pediatric EoE relates to clinically established parameters of fibrosis, including symptoms of esophageal dysfunction, endoscopic rings, and subepithelial fibrosis on biopsy.”

Results showed the DI was significantly lower in patients with fibrotic compared with inflammatory features on endoscopy (median [IQR], 3.3 (2.3-4.4) vs 5.5 [4.1-6.0]; P = .02) and showed no correlation with eosinophil count.

The researchers were able to propose a criteria for a rigid esophagus in children with EoE, writing that a DI below 4.5 mm²/mm Hg predicted grade 2 rings on endoscopy with area under the curve (AUC) of 0.81 (P = .0004). DI predicted food impaction in both unadjusted and adjusted models (fully adjusted odds ratio, 1.44; 95% CI, 1.02-2.14; P = .0486).

“This is a gamechanger in how we care for kids with EoE,” senior author Joshua Wechsler, MD, MSCI, medical director of the Eosinophilic Gastrointestinal Diseases Program at Lurie Children’s and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, said in a statement. “Now, if distensibility is low, we can dilate the esophagus during the same procedure, and because we can pinpoint exactly where the scarring is, our intervention is more targeted and takes much less time. We are seeing improvements in symptoms, which is incredibly exciting.”

Reference

Hoffmann NV, Keeley K, Wechsler JB. Esophageal distensibility defines fibrostenotic severity in pediatric eosinophilic esophagitis. Clin Gastroenterol Hepatol. Published online September 16, 2022. doi:10.1016/j.cgh.2022.08.044