Study links pediatric EoE treatment to reduced stiffening

Researchers from the Children’s Hospital of Philadelphia (CHOP) and the Children’s Hospital Colorado have found that controlling chronic eosinophilic esophagitis (EoE)-associated inflammation during childhood reduces esophageal stiffening and the likelihood of long-term disease complications. The findings, published in Gastroenterology, demonstrate that histologic remission is associated with improved esophageal distensibility over time, and baseline distensibility may predict which patients are at higher risk for fibrostenotic progression.^1,2

Background

EoE is a chronic allergic inflammatory disease of the esophagus, the muscular tube responsible for transporting food from the throat to the stomach. Symptoms in children include nausea, regurgitation, vomiting, abdominal pain, reflux-like burning, gagging, and difficulty swallowing. Dysphagia, the sensation of food sticking in the throat, is a frequent concern. Untreated EoE may result in esophageal narrowing due to scarring, also referred to as stricture.

Chronic EoE-associated inflammation can also lead to tissue remodeling and fibrostenosis, characterized by reduced esophageal flexibility. While the severity of EoE is recognized, the long-term influence of inflammation control during childhood on esophageal remodeling has remained unclear.

Study design

The research team conducted a prospective longitudinal study at CHOP and Children’s Hospital Colorado to evaluate the relationship between esophageal distensibility, histology, and fibrostenotic complications in pediatric EoE. A total of 112 children aged 3 to 18 years were included, undergoing 300 endoscopies during the study period. Participants were predominantly male (72.3%), with a mean age of 12.8 years. The median follow-up was 11 months, though some patients were followed for up to 4.5 years.

Investigators used impedance planimetry with endoluminal functional imaging (FLIP) during clinically necessary endoscopies to measure esophageal distensibility. Symptomatic, endoscopic, and histologic data were collected at each visit.

Results

Patients who demonstrated histologic response to treatment had the most significant improvement in esophageal distensibility over time (1.41 vs 0.16–0.53 mm/year, P = .003). After adjustment for esophageal reference score (EREFS) and age at symptom onset, lower esophageal distensibility was independently associated with higher odds of patient-reported dysphagia (odds ratio 0.85; 95% CI, 0.75–0.96; P = .008).

Children who developed fibrostenosis were typically older at diagnosis (9.9 vs 6.7 years; P = .032), had a longer disease duration (4.4 vs 2.4 years; P = .046), and had lower baseline distensibility (13.0 vs 14.9 mm; P = .012). Baseline distensibility also predicted the future need for stricture dilation (AUC 0.757; P = .0003).

Clinical implications

“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 co-senior study author Calies Menard-Katcher, MD, 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.”

“This is the first study to follow kids over time (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.”

The study suggests that measuring esophageal distensibility offers a quantifiable marker of tissue remodeling and may serve as a predictor of disease severity and progression. This tool may assist clinicians in identifying patients most likely to require more aggressive therapy or stricture dilation.

Next steps

The authors note that further research examining molecular mechanisms of EoE progression could refine risk stratification and help guide individualized therapy. “Having this data could help identify the patients who could benefit from these therapies the most,” Muir added.

The findings support the importance of early and consistent disease control in pediatric EoE to prevent long-term complications associated with esophageal remodeling and fibrostenosis.

References:

1. Children’s Hospital of Philadelphia. Children’s Hospital of Philadelphia and Children’s Hospital Colorado researchers conduct first prospective study of pediatric EoE patients and disease progression. Eurekalert. August 15, 2025. Accessed August 18, 2025. https://www.eurekalert.org/news-releases/1094933
2. Kennedy K, Burger C, Pan Z, et al. Histologic response is associated with improved esophageal distensibility and symptom burden in pediatric eosinophilic esophagitis. Gastroenterology. Published online August 11, 2025. doi:10.1053/j.gastro.2025.07.042