A new study has examined the long-term impacts of esophageal dilation in eosinophilic esophagitis (EoE). The aim was to uncover the link between dilation and symptom reports. Additionally, the research team wanted to uncover if there were an association between dilation and peak esophageal eosinophils per high-power field (eos/hpf).
Esophageal dilation has previously been shown to improve dysphagia. However, it isn’t associated with improvements in inflammation. Researchers suspect that dilation may hide associations between symptoms and biological endoscopy findings.
The Study
This study assessed EoE patients who were enrolled in the Consortium of Gastrointestinal Eosinophilic Disease Researchers (CEGIR) and the Outcome Measures for Eosinophilic Gastrointestinal Diseases Across Ages (OMEGA) study. The OMEGA study was a prospective observational investigation which occurred at multiple trial centers.
Patients in this trial had a median age of 37 years, and 61% were male. All 100 patients in the study were asked to complete the EEsAI which is the symptom based EoE activity index. These patients had a median disease duration of 9.7 years. On average, patients faced a delay in receiving their diagnosis of four years.
Patients were grouped by when they had their dilation.
- Dilation less than one year before endoscopy: 15 patients
- Dilation more than one year before endoscopy: 40 patients
- No dilation: 45 patients
Results
The primary finding of this investigation is that patient symptoms shouldn’t be used as an indicator of dilation response for the first year. This is because biologic findings from the biopsies during endoscopy procedures showed that there was inflammation even when patients reported no symptoms.
If patients report no symptoms, and therefore aren’t treated, this can have negative effects. Therefore, biologic findings must be considered for making patient’s treatment plans during the first year after dilation. Only examining symptoms can hide how severe the illness is.
For those without dilation, there was a moderate link between eos/hpf and patient reported symptoms. Additionally, with a 10-eos/hpf increase in this patient group, EEsAI increased 2.69. Further, there were no links between eos/hpf and patient symptoms for patients who were dilated less than one year and more than one year before an endoscopy.
A 10-eos/hpf increase led to an EEsAI change of -1.64 in those who were dilated less than a year prior to endoscopy and .78 for those dilated more than one year prior to endoscopy.
Looking Forward
Researchers emphasize that more clinical trials should be conducted to further investigate the link between symptom measures and other validated biological measures.
This trial shows response to treatment cannot simply be assessed by patient symptoms.
You can read more about these novel findings here.
