Researchers from Children's Hospital of Philadelphia (CHOP) and Children's Hospital Colorado have demonstrated that better control of chronic eosinophilic esophagitis (EoE)-associated inflammation during childhood leads to less stiffening of the esophagus and fewer disease complications. The landmark study, published in Gastroenterology, represents the first prospective longitudinal investigation to track disease progression in pediatric EoE patients using advanced imaging techniques.
Groundbreaking Longitudinal Study Design
The research team launched a comprehensive longitudinal study evaluating long-term changes in esophageal distensibility—the ability of the esophagus to expand—in pediatric patients between ages 3 and 18 years. A total of 112 patients with EoE were included, with a median follow-up time of 11 months and some patients followed for over 4 years. Symptomatic, endoscopic and histologic data were collected at each visit during the study.
"This is the first study to follow kids overtime (with these endoscopic assessments) and evaluate the patients who are at the highest risk of complications," said co-senior study author Amanda Muir, MD, a pediatric gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at CHOP. "With the recent FDA approval of two medications for EoE, having this data could help identify the patients who could benefit from these therapies the most and observe improvement at a histologic level over time."
Key Clinical Findings
The study utilized Endoluminal functional imaging (FLIP) to assess esophageal distensibility and found that patients with tissue samples showing a response to treatment demonstrated the most improvement in distensibility over time. After adjusting for different factors, researchers discovered that patients with lower esophageal distensibility had increased odds of patient-reported dysphagia, or difficulty swallowing.
Patients with fibrostenosis were generally diagnosed at an older age, had the disease for a longer period and showed reduced esophageal flexibility. Critically, measuring distensibility at baseline predicted the need for future dilation in patients with strictures, suggesting this parameter could serve as an important prognostic tool.
Clinical Implications for Disease Management
EoE is a chronic allergic inflammatory disease of the esophagus, the muscular tube that carries food from the throat to the stomach. Children can experience nausea, regurgitation, vomiting, abdominal pain and a burning feeling like acid reflux. They may also have difficulty swallowing and gag frequently, often experiencing dysphagia, which feels like something is stuck in their throat. If EoE goes untreated, the esophagus may narrow because of scarring, a phenomenon known as stricture.
Chronic EoE-associated inflammation can lead to progressive tissue remodeling and fibrostenosis, or the narrowing of the esophagus. While clinicians recognize the severity of the disease, long-term studies looking at disease progression over time, and the impact of controlling the disease from a young age, had been relatively unknown until this research.
"Following children living with EoE over time has given us a clearer picture of how inflammation affects the esophagus and how treating it can improve the esophagus and outcomes for patients," said Calies Menard-Katcher, MD, co-senior study author and Associate Director of Clinical Research for the Gastrointestinal Eosinophilic Diseases Program at Children's Hospital Colorado. "It's exciting to see these results confirm what we've suspected in caring for patients — and they may even help us spot those at risk for more severe disease."
Future Research Directions
The authors suggest that further studies examining the disease from a molecular level could help them understand which patients may be at highest risk of severe disease and could benefit from a variety of treatment strategies. The research team proposes that esophageal stiffness could serve as an important biomarker for disease progression and indicate which patients may benefit the most from current therapies.
This study was supported by the National Institutes of Health grants R01DK124266-01, K23DK109263 and R21TR003039. The findings were published online by Gastroenterology with the citation: Kennedy et al, "Histologic response is associated with improved esophageal distensibility and symptom burden in pediatric eosinophilic esophagitis." DOI: 10.1053/j.gastro.2025.07.042.
