Esophageal mechanical properties in different stages of pediatric eosinophilic esophagitis and based on different therapy interventions.

OBJECTIVES

We aim to categorize the mechanical properties of the esophagus in children with eosinophilic esophagitis (EoE) in different disease stages and based on different management modalities, using endoscopic functional luminal imaging probe (EndoFLIP) which has been established to objectively evaluate mechanical properties of the esophagus in patients with EoE.

METHODS

We performed a retrospective analysis of children who completed EndoFLIP during sedated endoscopy over 2 years. Patients with EoE were categorized into EoE remission or active EoE based on published guidelines. Control subjects were those with normal endoscopy, esophageal biopsies, and EndoFLIP parameters. EndoFLIP studies were analyzed for distensibility index (DI) and maximum diameter (MD) at the esophagogastric junction (EGJ), as well as contractile response (CR).

RESULTS

We included 130 subjects, 60 controls, and 70 with EoE (34 [49%] had active EoE and 36 [51%] were in remission). DI and MD were significantly lower in active EoE compared to controls (p < 0.001). DI and MD were significantly lower in initial (baseline) EoE compared to active EoE on therapy (p < 0.05) and EoE remission (p < 0.001). There was no statistically significant difference in DI and MD between EoE subgroups on different therapies.

CONCLUSION

Assessment of esophageal mechanical properties using EndoFLIP provides valuable information on disease severity in pediatric EoE. In our cohort, histological remission achieved with therapies such as proton pump inhibitors, topical steroids, and dupilumab was associated with improved distensibility and diameter at the EGJ. However, a subset of patients continued to demonstrate abnormal EndoFLIP findings despite histologic improvement.