Upper GI Tract

This study provides compelling evidence that a twice-daily dosing regimen of moderate-dose proton pump inhibitors (PPIs) is superior to a once-daily regimen for inducing histologic remission in eosinophilic esophagitis (EoE). This finding suggests a significant paradigm shift in EoE management, challenging the current standard treatment guideline that recommends a PPI trial of 20-40 mg twice daily. The limited data on various dosing regimens for EoE treatment underscores the importance of this research. Dr Muftah and colleagues from Brigham and Women's Hospital have conducted a novel retrospective cohort study to address the question: Does a twice-daily PPI dose induce a higher remission rate in EoE than a once-daily regimen does regardless of the total daily dose?

The study enrolled adult patients with newly-diagnosed treatment-naive EoE at a tertiary care center, dividing participants into four groups on the basis of their treatment regimen: once-daily standard dose (20 mg omeprazole), once-daily moderate dose (40 mg), twice-daily moderate dose (20 mg), and twice-daily high dose (40 mg). Patients underwent endoscopy 8-12 weeks after initiating PPI treatment, with the primary outcome being the histologic response to PPI, defined as fewer than 15 eosinophils/high power field in repeat esophageal biopsies.

Out of 305 patients (54.6% men, mean age 44.7 ± 16.7 years), 42.3% achieved a histologic response to PPI treatment. Patients receiving the standard PPI dose (20 mg omeprazole once daily) vs those on twice-daily moderate and high doses showed significantly higher histologic response rates (52.8% vs 11.8%, P < .0001; and 54.3% vs 11.8%, P < .0001; respectively). Multivariable analysis revealed that twice-daily moderate and high doses were significantly more effective (adjusted odds ration [aOR] 6.75; CI 2.53-18.0, P = .0008; and aOR 12.8, CI 4.69-34.8, P < .001; respectively).

However, the study's retrospective design limits its ability to establish causality and may introduce selection bias. In addition, the lack of specified adjustments for PPI dosing based on diet and lifestyle factors across the cohort could influence treatment response and outcomes. Last, as a single-center study, the results may not generalize across diverse patient populations, particularly those with different demographics or disease severities.

This research heralds a shift toward a more effective treatment strategy in EoE management, suggesting that a twice-daily PPI regimen may be more beneficial than once-daily dosing is for inducing histologic remission, especially in patients inadequately responding to once-daily PPI treatment. It advocates for a personalized treatment approach, considering factors such as symptom severity, previous PPI response, and potential for adherence to a twice-daily regimen.

Distinguishing between inflammatory bowel disease (IBD)–induced eosinophilia and EoE poses a significant challenge for clinicians. Given that the incidence of EoE is 3-5 times higher in patients with IBD compared with the general population, there is a pressing need for new biomarkers to differentiate between these two conditions. In response to this need, Dr Butzke and colleagues at Nemours Children's Health in Wilmington, Delaware, conducted a retrospective study to evaluate the roles of Major Basic Protein (MBP) and interleukin (IL)-13 in distinguishing these diseases. The study included participants who underwent esophagogastroduodenoscopy with esophageal biopsies for IBD workup or suspicion of EoE. It comprised 27 patients with EoE-IBD, 39 with EoE, 29 with IBD eosinophilia, 30 with IBD only, and 30 control patients. The biopsies were stained with MBP and IL-13 antibodies, and the results (percent staining/total tissue area), demographic, and clinical findings were compared among the groups.

The study revealed that MBP staining levels among patients with EoE-IBD were 3.8 units, which is significantly lower than those in the EoE group at 52.8 units and higher than those with IBD eosinophilia at 0.2 units (P < .001). IL-13 expression was significantly higher only compared with the IBD and control groups and not with EoE-IBD or IBD eosinophilia. MBP predicted EoE with 100% sensitivity and 99% specificity, whereas IL-13 demonstrated 83% sensitivity and 90% specificity using a cutoff point from the cohort of patients without EoE-IBD. Based on the MBP cutoff point of 3.49 units that distinguished between EoE and non-EoE cases, 100% of patients with EoE were MBP-positive compared with 3% of patients with IBD-associated eosinophilia (P < .05).

To implement this new biomarker into clinical practice, guidelines for interpreting MBP staining results should be developed and established, including defining cutoff points for positive and negative results. However, this study faces several limitations, such as not evaluating the differences in MBP results based on EoE-IBD type and disease activity. The retrospective nature of the study and its small sample size limit its power. In addition, the study did not assess how different treatments and disease activity affect MBP levels nor did it address the lack of longitudinal evaluation in assessing MBP levels.

Despite these limitations, the study presents a compelling case for the use of MBP as a biomarker to distinguish true EoE from EoE-IBD. This differentiation is crucial because it can guide therapeutic approaches, influencing medication choices and dietary interventions. MBP shows promise as an excellent biomarker for distinguishing true EoE from eosinophilia caused by IBD. When combined with endoscopic and histologic changes, MBP can assist with the diagnosis of EoE in IBD patients, thereby reducing the possibility of misdiagnosis.

Being diagnosed with EoE poses a challenging and life-altering experience for patients and their families. They face numerous challenges, from undergoing diagnostic procedures and treatments to adapting daily diets. Limited information is available on the eating habits of patients diagnosed with EoE. In this study, Dr Kennedy and colleagues explored how a diagnosis of EoE affects eating behaviors among pediatric patients.

The researchers conducted a prospective study involving 27 patients diagnosed with EoE and compared their eating behaviors to those of 25 healthy control participants. The participants were evaluated on the basis of their responses to four food textures (puree, soft solid, chewable, and hard solid), focusing on the number of chews per bite, sips of fluid per food, and consumption time.

The study found that, on average, patients with EoE (63.5% boys, mean age 11 years) required more chews per bite across several food textures (soft solid P = .031; chewable P = .047; and hard solid P = .037) and demonstrated increased consumption time for soft solid (P = .002), chewable (P = .005), and hard solid foods (P = .034) compared to healthy controls. In addition, endoscopic reference scores positively correlated with consumption time (r = 0.53; P = .008) and the number of chews (r = 0.45; P = .027) for chewable foods as well as with the number of chews (r = 0.44; P = .043) for hard solid foods. Increased consumption time also correlated with increased eosinophil counts (r = 0.42; P = .050) and decreased esophageal distensibility (r = -0.82; P < .0001).

Though these findings open promising avenues for the noninvasive assessment and personalized management of EoE, further research with larger, longitudinal studies is essential to validate these behaviors as reliable clinical biomarkers. Increasing the sample size would enhance the study's power and broaden the generalizability of its findings to a wider pediatric EoE population. The study's cross-sectional nature limits the ability to assess how eating behaviors change over time with treatment or disease progression.

This study underscores the potential of eating behaviors as clinical markers for pediatric patients with EoE, enabling early identification through increased chewing and consumption times, especially with harder textures. Such markers could prompt diagnostic evaluations in settings where endoscopy and biopsy are gold standards for diagnosing EoE. Moreover, eating patterns could assist in monitoring disease activity and progression, offering a noninvasive means of assessing disease status and response to therapy, thus allowing for more frequent assessments of disease status without the need for invasive procedures. Understanding these behaviors allows healthcare providers to tailor dietary advice and interventions, potentially enhancing treatment compliance and improving the quality of life for pediatric patients with EoE.

This study provides compelling evidence that a twice-daily dosing regimen of moderate-dose proton pump inhibitors (PPIs) is superior to a once-daily regimen for inducing histologic remission in eosinophilic esophagitis (EoE). This finding suggests a significant paradigm shift in EoE management, challenging the current standard treatment guideline that recommends a PPI trial of 20-40 mg twice daily. The limited data on various dosing regimens for EoE treatment underscores the importance of this research. Dr Muftah and colleagues from Brigham and Women's Hospital have conducted a novel retrospective cohort study to address the question: Does a twice-daily PPI dose induce a higher remission rate in EoE than a once-daily regimen does regardless of the total daily dose?

The study enrolled adult patients with newly-diagnosed treatment-naive EoE at a tertiary care center, dividing participants into four groups on the basis of their treatment regimen: once-daily standard dose (20 mg omeprazole), once-daily moderate dose (40 mg), twice-daily moderate dose (20 mg), and twice-daily high dose (40 mg). Patients underwent endoscopy 8-12 weeks after initiating PPI treatment, with the primary outcome being the histologic response to PPI, defined as fewer than 15 eosinophils/high power field in repeat esophageal biopsies.

Out of 305 patients (54.6% men, mean age 44.7 ± 16.7 years), 42.3% achieved a histologic response to PPI treatment. Patients receiving the standard PPI dose (20 mg omeprazole once daily) vs those on twice-daily moderate and high doses showed significantly higher histologic response rates (52.8% vs 11.8%, P < .0001; and 54.3% vs 11.8%, P < .0001; respectively). Multivariable analysis revealed that twice-daily moderate and high doses were significantly more effective (adjusted odds ration [aOR] 6.75; CI 2.53-18.0, P = .0008; and aOR 12.8, CI 4.69-34.8, P < .001; respectively).

However, the study's retrospective design limits its ability to establish causality and may introduce selection bias. In addition, the lack of specified adjustments for PPI dosing based on diet and lifestyle factors across the cohort could influence treatment response and outcomes. Last, as a single-center study, the results may not generalize across diverse patient populations, particularly those with different demographics or disease severities.

This research heralds a shift toward a more effective treatment strategy in EoE management, suggesting that a twice-daily PPI regimen may be more beneficial than once-daily dosing is for inducing histologic remission, especially in patients inadequately responding to once-daily PPI treatment. It advocates for a personalized treatment approach, considering factors such as symptom severity, previous PPI response, and potential for adherence to a twice-daily regimen.

Distinguishing between inflammatory bowel disease (IBD)–induced eosinophilia and EoE poses a significant challenge for clinicians. Given that the incidence of EoE is 3-5 times higher in patients with IBD compared with the general population, there is a pressing need for new biomarkers to differentiate between these two conditions. In response to this need, Dr Butzke and colleagues at Nemours Children's Health in Wilmington, Delaware, conducted a retrospective study to evaluate the roles of Major Basic Protein (MBP) and interleukin (IL)-13 in distinguishing these diseases. The study included participants who underwent esophagogastroduodenoscopy with esophageal biopsies for IBD workup or suspicion of EoE. It comprised 27 patients with EoE-IBD, 39 with EoE, 29 with IBD eosinophilia, 30 with IBD only, and 30 control patients. The biopsies were stained with MBP and IL-13 antibodies, and the results (percent staining/total tissue area), demographic, and clinical findings were compared among the groups.

The study revealed that MBP staining levels among patients with EoE-IBD were 3.8 units, which is significantly lower than those in the EoE group at 52.8 units and higher than those with IBD eosinophilia at 0.2 units (P < .001). IL-13 expression was significantly higher only compared with the IBD and control groups and not with EoE-IBD or IBD eosinophilia. MBP predicted EoE with 100% sensitivity and 99% specificity, whereas IL-13 demonstrated 83% sensitivity and 90% specificity using a cutoff point from the cohort of patients without EoE-IBD. Based on the MBP cutoff point of 3.49 units that distinguished between EoE and non-EoE cases, 100% of patients with EoE were MBP-positive compared with 3% of patients with IBD-associated eosinophilia (P < .05).

To implement this new biomarker into clinical practice, guidelines for interpreting MBP staining results should be developed and established, including defining cutoff points for positive and negative results. However, this study faces several limitations, such as not evaluating the differences in MBP results based on EoE-IBD type and disease activity. The retrospective nature of the study and its small sample size limit its power. In addition, the study did not assess how different treatments and disease activity affect MBP levels nor did it address the lack of longitudinal evaluation in assessing MBP levels.

Despite these limitations, the study presents a compelling case for the use of MBP as a biomarker to distinguish true EoE from EoE-IBD. This differentiation is crucial because it can guide therapeutic approaches, influencing medication choices and dietary interventions. MBP shows promise as an excellent biomarker for distinguishing true EoE from eosinophilia caused by IBD. When combined with endoscopic and histologic changes, MBP can assist with the diagnosis of EoE in IBD patients, thereby reducing the possibility of misdiagnosis.

Being diagnosed with EoE poses a challenging and life-altering experience for patients and their families. They face numerous challenges, from undergoing diagnostic procedures and treatments to adapting daily diets. Limited information is available on the eating habits of patients diagnosed with EoE. In this study, Dr Kennedy and colleagues explored how a diagnosis of EoE affects eating behaviors among pediatric patients.

The researchers conducted a prospective study involving 27 patients diagnosed with EoE and compared their eating behaviors to those of 25 healthy control participants. The participants were evaluated on the basis of their responses to four food textures (puree, soft solid, chewable, and hard solid), focusing on the number of chews per bite, sips of fluid per food, and consumption time.

The study found that, on average, patients with EoE (63.5% boys, mean age 11 years) required more chews per bite across several food textures (soft solid P = .031; chewable P = .047; and hard solid P = .037) and demonstrated increased consumption time for soft solid (P = .002), chewable (P = .005), and hard solid foods (P = .034) compared to healthy controls. In addition, endoscopic reference scores positively correlated with consumption time (r = 0.53; P = .008) and the number of chews (r = 0.45; P = .027) for chewable foods as well as with the number of chews (r = 0.44; P = .043) for hard solid foods. Increased consumption time also correlated with increased eosinophil counts (r = 0.42; P = .050) and decreased esophageal distensibility (r = -0.82; P < .0001).

Though these findings open promising avenues for the noninvasive assessment and personalized management of EoE, further research with larger, longitudinal studies is essential to validate these behaviors as reliable clinical biomarkers. Increasing the sample size would enhance the study's power and broaden the generalizability of its findings to a wider pediatric EoE population. The study's cross-sectional nature limits the ability to assess how eating behaviors change over time with treatment or disease progression.

This study underscores the potential of eating behaviors as clinical markers for pediatric patients with EoE, enabling early identification through increased chewing and consumption times, especially with harder textures. Such markers could prompt diagnostic evaluations in settings where endoscopy and biopsy are gold standards for diagnosing EoE. Moreover, eating patterns could assist in monitoring disease activity and progression, offering a noninvasive means of assessing disease status and response to therapy, thus allowing for more frequent assessments of disease status without the need for invasive procedures. Understanding these behaviors allows healthcare providers to tailor dietary advice and interventions, potentially enhancing treatment compliance and improving the quality of life for pediatric patients with EoE.

This study provides compelling evidence that a twice-daily dosing regimen of moderate-dose proton pump inhibitors (PPIs) is superior to a once-daily regimen for inducing histologic remission in eosinophilic esophagitis (EoE). This finding suggests a significant paradigm shift in EoE management, challenging the current standard treatment guideline that recommends a PPI trial of 20-40 mg twice daily. The limited data on various dosing regimens for EoE treatment underscores the importance of this research. Dr Muftah and colleagues from Brigham and Women's Hospital have conducted a novel retrospective cohort study to address the question: Does a twice-daily PPI dose induce a higher remission rate in EoE than a once-daily regimen does regardless of the total daily dose?

The study enrolled adult patients with newly-diagnosed treatment-naive EoE at a tertiary care center, dividing participants into four groups on the basis of their treatment regimen: once-daily standard dose (20 mg omeprazole), once-daily moderate dose (40 mg), twice-daily moderate dose (20 mg), and twice-daily high dose (40 mg). Patients underwent endoscopy 8-12 weeks after initiating PPI treatment, with the primary outcome being the histologic response to PPI, defined as fewer than 15 eosinophils/high power field in repeat esophageal biopsies.

Out of 305 patients (54.6% men, mean age 44.7 ± 16.7 years), 42.3% achieved a histologic response to PPI treatment. Patients receiving the standard PPI dose (20 mg omeprazole once daily) vs those on twice-daily moderate and high doses showed significantly higher histologic response rates (52.8% vs 11.8%, P < .0001; and 54.3% vs 11.8%, P < .0001; respectively). Multivariable analysis revealed that twice-daily moderate and high doses were significantly more effective (adjusted odds ration [aOR] 6.75; CI 2.53-18.0, P = .0008; and aOR 12.8, CI 4.69-34.8, P < .001; respectively).

However, the study's retrospective design limits its ability to establish causality and may introduce selection bias. In addition, the lack of specified adjustments for PPI dosing based on diet and lifestyle factors across the cohort could influence treatment response and outcomes. Last, as a single-center study, the results may not generalize across diverse patient populations, particularly those with different demographics or disease severities.

This research heralds a shift toward a more effective treatment strategy in EoE management, suggesting that a twice-daily PPI regimen may be more beneficial than once-daily dosing is for inducing histologic remission, especially in patients inadequately responding to once-daily PPI treatment. It advocates for a personalized treatment approach, considering factors such as symptom severity, previous PPI response, and potential for adherence to a twice-daily regimen.

Distinguishing between inflammatory bowel disease (IBD)–induced eosinophilia and EoE poses a significant challenge for clinicians. Given that the incidence of EoE is 3-5 times higher in patients with IBD compared with the general population, there is a pressing need for new biomarkers to differentiate between these two conditions. In response to this need, Dr Butzke and colleagues at Nemours Children's Health in Wilmington, Delaware, conducted a retrospective study to evaluate the roles of Major Basic Protein (MBP) and interleukin (IL)-13 in distinguishing these diseases. The study included participants who underwent esophagogastroduodenoscopy with esophageal biopsies for IBD workup or suspicion of EoE. It comprised 27 patients with EoE-IBD, 39 with EoE, 29 with IBD eosinophilia, 30 with IBD only, and 30 control patients. The biopsies were stained with MBP and IL-13 antibodies, and the results (percent staining/total tissue area), demographic, and clinical findings were compared among the groups.

The study revealed that MBP staining levels among patients with EoE-IBD were 3.8 units, which is significantly lower than those in the EoE group at 52.8 units and higher than those with IBD eosinophilia at 0.2 units (P < .001). IL-13 expression was significantly higher only compared with the IBD and control groups and not with EoE-IBD or IBD eosinophilia. MBP predicted EoE with 100% sensitivity and 99% specificity, whereas IL-13 demonstrated 83% sensitivity and 90% specificity using a cutoff point from the cohort of patients without EoE-IBD. Based on the MBP cutoff point of 3.49 units that distinguished between EoE and non-EoE cases, 100% of patients with EoE were MBP-positive compared with 3% of patients with IBD-associated eosinophilia (P < .05).

To implement this new biomarker into clinical practice, guidelines for interpreting MBP staining results should be developed and established, including defining cutoff points for positive and negative results. However, this study faces several limitations, such as not evaluating the differences in MBP results based on EoE-IBD type and disease activity. The retrospective nature of the study and its small sample size limit its power. In addition, the study did not assess how different treatments and disease activity affect MBP levels nor did it address the lack of longitudinal evaluation in assessing MBP levels.

Despite these limitations, the study presents a compelling case for the use of MBP as a biomarker to distinguish true EoE from EoE-IBD. This differentiation is crucial because it can guide therapeutic approaches, influencing medication choices and dietary interventions. MBP shows promise as an excellent biomarker for distinguishing true EoE from eosinophilia caused by IBD. When combined with endoscopic and histologic changes, MBP can assist with the diagnosis of EoE in IBD patients, thereby reducing the possibility of misdiagnosis.

Being diagnosed with EoE poses a challenging and life-altering experience for patients and their families. They face numerous challenges, from undergoing diagnostic procedures and treatments to adapting daily diets. Limited information is available on the eating habits of patients diagnosed with EoE. In this study, Dr Kennedy and colleagues explored how a diagnosis of EoE affects eating behaviors among pediatric patients.

The researchers conducted a prospective study involving 27 patients diagnosed with EoE and compared their eating behaviors to those of 25 healthy control participants. The participants were evaluated on the basis of their responses to four food textures (puree, soft solid, chewable, and hard solid), focusing on the number of chews per bite, sips of fluid per food, and consumption time.

The study found that, on average, patients with EoE (63.5% boys, mean age 11 years) required more chews per bite across several food textures (soft solid P = .031; chewable P = .047; and hard solid P = .037) and demonstrated increased consumption time for soft solid (P = .002), chewable (P = .005), and hard solid foods (P = .034) compared to healthy controls. In addition, endoscopic reference scores positively correlated with consumption time (r = 0.53; P = .008) and the number of chews (r = 0.45; P = .027) for chewable foods as well as with the number of chews (r = 0.44; P = .043) for hard solid foods. Increased consumption time also correlated with increased eosinophil counts (r = 0.42; P = .050) and decreased esophageal distensibility (r = -0.82; P < .0001).

Though these findings open promising avenues for the noninvasive assessment and personalized management of EoE, further research with larger, longitudinal studies is essential to validate these behaviors as reliable clinical biomarkers. Increasing the sample size would enhance the study's power and broaden the generalizability of its findings to a wider pediatric EoE population. The study's cross-sectional nature limits the ability to assess how eating behaviors change over time with treatment or disease progression.

This study underscores the potential of eating behaviors as clinical markers for pediatric patients with EoE, enabling early identification through increased chewing and consumption times, especially with harder textures. Such markers could prompt diagnostic evaluations in settings where endoscopy and biopsy are gold standards for diagnosing EoE. Moreover, eating patterns could assist in monitoring disease activity and progression, offering a noninvasive means of assessing disease status and response to therapy, thus allowing for more frequent assessments of disease status without the need for invasive procedures. Understanding these behaviors allows healthcare providers to tailor dietary advice and interventions, potentially enhancing treatment compliance and improving the quality of life for pediatric patients with EoE.

Severe, refractory, and fibrostenotic eosinophilic esophagitis (EoE) responded well in the everyday clinical setting to the monoclonal antibody dupilumab (Dupixent). Most patients achieved histologic, endoscopic, and symptom improvement with a median of 6 months’ treatment with the interleukin 4 and 13 blocker, and esophageal stricture diameter improved as well, according to a single-center retrospective study in Clinical Gastroenterology and Hepatology.

“Dupilumab has real-world efficacy for a severe EoE population, most of whom would not have qualified for prior clinical trials,” concluded gastroenterologists Christopher J. Lee, MD (lead author), and Evan S. Dellon, MD, MPH, AGAF, of the Center for Esophageal Diseases and Swallowing, at the University of North Carolina School of Medicine in Chapel Hill.

These real-world findings aligned with data from the group’s phase 3 clinical trial.

In addition, several case reports or series have highlighted the real-world efficacy of dupilumab, with a particular focus on pediatric patients and those with other atopic diseases.

“Despite nonresponse to prior treatments, these patients can likely expect to see results similar to what was seen in the clinical trial,” Dr. Dellon said in an interview. “However, it would be good to have similar confirmatory data from other centers, and I’m sure those data will be forthcoming as more EoE patients are treated with dupilumab.”

The study

The investigators identified 46 patients treated with dupilumab for refractory fibrostenotic EoE at the university’s medical center. All had failed or lost response to one or more standard therapies such as proton pump inhibitors, topical glucocorticosteroids, and a food elimination diet.

Previous treatments also included systemic steroids, cromolyn, ketotifen, montelukast, and 6-mercaptopurine, all with minimal response. Some 85% of patients had undergone an average of 9.0+ 7.0 pre-dupilumab dilations.

The biologic was initially prescribed off-label before FDA approval. Patients received it at a dose of 300 mg subcutaneously either fortnightly (n = 16) or weekly (n = 30), depending on insurance approval and timing of prescription. Length of treatment varied based on the time from prescription to first post-treatment evaluative endoscopy.

Patients showed endoscopic, histologic, and symptomatic improvement on dupilumab compared with both the worst and the pre-dupilumab esophagogastroduodenoscopies.

Among the specific findings:

• Peak eosinophil counts significantly decreased.
• Post-dupilumab histologic response rates were 80% and 57% for fewer than 15 eosinophils per high-power field, and 6 or fewer eosinophils per high-power field, respectively.
• The Endoscopic Reference Score decreased from 5.01 to 1.89 (P < .001 for all).
• Pre-dilation esophageal diameter increased from 13.9 to 16.0 mm (P < .001), although the proportion of strictures was stable.
• Global symptom improvement was reported in 91% of patients (P < .001).

Commenting on the study but not involved in it, David A. Katzka, MD, professor of medicine at Columbia University in New York City, said the findings would be of immediate use to practicing gastroenterologists.

“It’s necessary to do clinical trials, but real-world data make the clinician feel more comfortable in prescribing. Interestingly, I am seeing dupilumab being recommended not just for refractory disease but also as first-line therapy,” he said.

Dr. Dellon noted that the incidence and prevalence of EoE are rising rapidly in the US and around the world. “This increase is outpacing growing recognition of the disease,” he said. “Most likely, environmental factors are driving this change.” He called for studies to determine the long-term efficacy of dupilumab for this severe subgroup — and the potential benefit of moving dupilumab earlier into the treatment algorithm.

The latter is a controversial question, noted Dr. Katzka. “For patients with other indications such as asthma or eczema, dupilumab is the ideal medication,” he said. And it can be a first-line therapy if there are contraindications to alternatives or if compliance will be better with a once-weekly injection as opposed to a twice-daily medication or a food elimination diet. But overall, our more established therapies should be considered first.”

Dr. Katzka emphasized the need to further define EoE phenotypes in order to personalize therapy. “There’s likely a group of patients who should go straight to dupilumab, perhaps those marked by factors such as severity, progression, young age, or other atopic disorders. But we have yet to definitively identify this group.” 

The authors reported no specific funding for this analysis. Dr. Dellon reported research funding and/or consulting fees from multiple pharmaceutical companies, including Regeneron/Sanofi, the developers of dupilumab. Dr. Lee had no competing interests to disclose. Dr. Katzka reported consulting for Medtronic, and is an associate editor for GI & Hepatology News.

Severe, refractory, and fibrostenotic eosinophilic esophagitis (EoE) responded well in the everyday clinical setting to the monoclonal antibody dupilumab (Dupixent). Most patients achieved histologic, endoscopic, and symptom improvement with a median of 6 months’ treatment with the interleukin 4 and 13 blocker, and esophageal stricture diameter improved as well, according to a single-center retrospective study in Clinical Gastroenterology and Hepatology.

“Dupilumab has real-world efficacy for a severe EoE population, most of whom would not have qualified for prior clinical trials,” concluded gastroenterologists Christopher J. Lee, MD (lead author), and Evan S. Dellon, MD, MPH, AGAF, of the Center for Esophageal Diseases and Swallowing, at the University of North Carolina School of Medicine in Chapel Hill.

These real-world findings aligned with data from the group’s phase 3 clinical trial.

In addition, several case reports or series have highlighted the real-world efficacy of dupilumab, with a particular focus on pediatric patients and those with other atopic diseases.

“Despite nonresponse to prior treatments, these patients can likely expect to see results similar to what was seen in the clinical trial,” Dr. Dellon said in an interview. “However, it would be good to have similar confirmatory data from other centers, and I’m sure those data will be forthcoming as more EoE patients are treated with dupilumab.”

The study

The investigators identified 46 patients treated with dupilumab for refractory fibrostenotic EoE at the university’s medical center. All had failed or lost response to one or more standard therapies such as proton pump inhibitors, topical glucocorticosteroids, and a food elimination diet.

Previous treatments also included systemic steroids, cromolyn, ketotifen, montelukast, and 6-mercaptopurine, all with minimal response. Some 85% of patients had undergone an average of 9.0+ 7.0 pre-dupilumab dilations.

The biologic was initially prescribed off-label before FDA approval. Patients received it at a dose of 300 mg subcutaneously either fortnightly (n = 16) or weekly (n = 30), depending on insurance approval and timing of prescription. Length of treatment varied based on the time from prescription to first post-treatment evaluative endoscopy.

Patients showed endoscopic, histologic, and symptomatic improvement on dupilumab compared with both the worst and the pre-dupilumab esophagogastroduodenoscopies.

Among the specific findings:

• Peak eosinophil counts significantly decreased.
• Post-dupilumab histologic response rates were 80% and 57% for fewer than 15 eosinophils per high-power field, and 6 or fewer eosinophils per high-power field, respectively.
• The Endoscopic Reference Score decreased from 5.01 to 1.89 (P < .001 for all).
• Pre-dilation esophageal diameter increased from 13.9 to 16.0 mm (P < .001), although the proportion of strictures was stable.
• Global symptom improvement was reported in 91% of patients (P < .001).

Commenting on the study but not involved in it, David A. Katzka, MD, professor of medicine at Columbia University in New York City, said the findings would be of immediate use to practicing gastroenterologists.

“It’s necessary to do clinical trials, but real-world data make the clinician feel more comfortable in prescribing. Interestingly, I am seeing dupilumab being recommended not just for refractory disease but also as first-line therapy,” he said.

Dr. Dellon noted that the incidence and prevalence of EoE are rising rapidly in the US and around the world. “This increase is outpacing growing recognition of the disease,” he said. “Most likely, environmental factors are driving this change.” He called for studies to determine the long-term efficacy of dupilumab for this severe subgroup — and the potential benefit of moving dupilumab earlier into the treatment algorithm.

The latter is a controversial question, noted Dr. Katzka. “For patients with other indications such as asthma or eczema, dupilumab is the ideal medication,” he said. And it can be a first-line therapy if there are contraindications to alternatives or if compliance will be better with a once-weekly injection as opposed to a twice-daily medication or a food elimination diet. But overall, our more established therapies should be considered first.”

Dr. Katzka emphasized the need to further define EoE phenotypes in order to personalize therapy. “There’s likely a group of patients who should go straight to dupilumab, perhaps those marked by factors such as severity, progression, young age, or other atopic disorders. But we have yet to definitively identify this group.” 

The authors reported no specific funding for this analysis. Dr. Dellon reported research funding and/or consulting fees from multiple pharmaceutical companies, including Regeneron/Sanofi, the developers of dupilumab. Dr. Lee had no competing interests to disclose. Dr. Katzka reported consulting for Medtronic, and is an associate editor for GI & Hepatology News.

Severe, refractory, and fibrostenotic eosinophilic esophagitis (EoE) responded well in the everyday clinical setting to the monoclonal antibody dupilumab (Dupixent). Most patients achieved histologic, endoscopic, and symptom improvement with a median of 6 months’ treatment with the interleukin 4 and 13 blocker, and esophageal stricture diameter improved as well, according to a single-center retrospective study in Clinical Gastroenterology and Hepatology.

“Dupilumab has real-world efficacy for a severe EoE population, most of whom would not have qualified for prior clinical trials,” concluded gastroenterologists Christopher J. Lee, MD (lead author), and Evan S. Dellon, MD, MPH, AGAF, of the Center for Esophageal Diseases and Swallowing, at the University of North Carolina School of Medicine in Chapel Hill.

These real-world findings aligned with data from the group’s phase 3 clinical trial.

In addition, several case reports or series have highlighted the real-world efficacy of dupilumab, with a particular focus on pediatric patients and those with other atopic diseases.

“Despite nonresponse to prior treatments, these patients can likely expect to see results similar to what was seen in the clinical trial,” Dr. Dellon said in an interview. “However, it would be good to have similar confirmatory data from other centers, and I’m sure those data will be forthcoming as more EoE patients are treated with dupilumab.”

The study

The investigators identified 46 patients treated with dupilumab for refractory fibrostenotic EoE at the university’s medical center. All had failed or lost response to one or more standard therapies such as proton pump inhibitors, topical glucocorticosteroids, and a food elimination diet.

Previous treatments also included systemic steroids, cromolyn, ketotifen, montelukast, and 6-mercaptopurine, all with minimal response. Some 85% of patients had undergone an average of 9.0+ 7.0 pre-dupilumab dilations.

The biologic was initially prescribed off-label before FDA approval. Patients received it at a dose of 300 mg subcutaneously either fortnightly (n = 16) or weekly (n = 30), depending on insurance approval and timing of prescription. Length of treatment varied based on the time from prescription to first post-treatment evaluative endoscopy.

Patients showed endoscopic, histologic, and symptomatic improvement on dupilumab compared with both the worst and the pre-dupilumab esophagogastroduodenoscopies.

Among the specific findings:

• Peak eosinophil counts significantly decreased.
• Post-dupilumab histologic response rates were 80% and 57% for fewer than 15 eosinophils per high-power field, and 6 or fewer eosinophils per high-power field, respectively.
• The Endoscopic Reference Score decreased from 5.01 to 1.89 (P < .001 for all).
• Pre-dilation esophageal diameter increased from 13.9 to 16.0 mm (P < .001), although the proportion of strictures was stable.
• Global symptom improvement was reported in 91% of patients (P < .001).

Commenting on the study but not involved in it, David A. Katzka, MD, professor of medicine at Columbia University in New York City, said the findings would be of immediate use to practicing gastroenterologists.

“It’s necessary to do clinical trials, but real-world data make the clinician feel more comfortable in prescribing. Interestingly, I am seeing dupilumab being recommended not just for refractory disease but also as first-line therapy,” he said.

Dr. Dellon noted that the incidence and prevalence of EoE are rising rapidly in the US and around the world. “This increase is outpacing growing recognition of the disease,” he said. “Most likely, environmental factors are driving this change.” He called for studies to determine the long-term efficacy of dupilumab for this severe subgroup — and the potential benefit of moving dupilumab earlier into the treatment algorithm.

The latter is a controversial question, noted Dr. Katzka. “For patients with other indications such as asthma or eczema, dupilumab is the ideal medication,” he said. And it can be a first-line therapy if there are contraindications to alternatives or if compliance will be better with a once-weekly injection as opposed to a twice-daily medication or a food elimination diet. But overall, our more established therapies should be considered first.”

Dr. Katzka emphasized the need to further define EoE phenotypes in order to personalize therapy. “There’s likely a group of patients who should go straight to dupilumab, perhaps those marked by factors such as severity, progression, young age, or other atopic disorders. But we have yet to definitively identify this group.” 

The authors reported no specific funding for this analysis. Dr. Dellon reported research funding and/or consulting fees from multiple pharmaceutical companies, including Regeneron/Sanofi, the developers of dupilumab. Dr. Lee had no competing interests to disclose. Dr. Katzka reported consulting for Medtronic, and is an associate editor for GI & Hepatology News.

Key clinical point: Reduced symptom severity and use of budesonide orodispersible tablets and high topical corticosteroid (tC) doses (eg, fluticasone propionate metered dose ≥ 1 mg/day from inhalation devices) are all independent predictors of tC effectiveness in patients with eosinophilic esophagitis (EoE) in the real‐world setting.

Major finding: Corticosteroid treatment proved to be the most important determining factor in achieving clinico-histological remission, with budesonide orodispersible tablets presenting the highest efficacy (adjusted odds ratio [aOR], 18.9; P < .001). High tC doses (aOR, 4.3; P = .03) and lower symptom scores (aOR, 0.9; P = .01) were also significant predictors of tC effectiveness.

Study details: This real-world cross‐sectional analysis of the multicenter EoE CONNECT registry assessed the data on 1456 prescriptions of tC monotherapy used in 866 patients with EoE.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Laserna‐Mendieta EJ, Navarro P, Casabona-Francés S, et al. Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real‐world efficacy from the EoE CONNECT registry. United European Gastroenterol J. Published online January 29, 2024. Source

Key clinical point: Reduced symptom severity and use of budesonide orodispersible tablets and high topical corticosteroid (tC) doses (eg, fluticasone propionate metered dose ≥ 1 mg/day from inhalation devices) are all independent predictors of tC effectiveness in patients with eosinophilic esophagitis (EoE) in the real‐world setting.

Major finding: Corticosteroid treatment proved to be the most important determining factor in achieving clinico-histological remission, with budesonide orodispersible tablets presenting the highest efficacy (adjusted odds ratio [aOR], 18.9; P < .001). High tC doses (aOR, 4.3; P = .03) and lower symptom scores (aOR, 0.9; P = .01) were also significant predictors of tC effectiveness.

Study details: This real-world cross‐sectional analysis of the multicenter EoE CONNECT registry assessed the data on 1456 prescriptions of tC monotherapy used in 866 patients with EoE.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Laserna‐Mendieta EJ, Navarro P, Casabona-Francés S, et al. Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real‐world efficacy from the EoE CONNECT registry. United European Gastroenterol J. Published online January 29, 2024. Source

Key clinical point: Reduced symptom severity and use of budesonide orodispersible tablets and high topical corticosteroid (tC) doses (eg, fluticasone propionate metered dose ≥ 1 mg/day from inhalation devices) are all independent predictors of tC effectiveness in patients with eosinophilic esophagitis (EoE) in the real‐world setting.

Major finding: Corticosteroid treatment proved to be the most important determining factor in achieving clinico-histological remission, with budesonide orodispersible tablets presenting the highest efficacy (adjusted odds ratio [aOR], 18.9; P < .001). High tC doses (aOR, 4.3; P = .03) and lower symptom scores (aOR, 0.9; P = .01) were also significant predictors of tC effectiveness.

Study details: This real-world cross‐sectional analysis of the multicenter EoE CONNECT registry assessed the data on 1456 prescriptions of tC monotherapy used in 866 patients with EoE.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Laserna‐Mendieta EJ, Navarro P, Casabona-Francés S, et al. Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real‐world efficacy from the EoE CONNECT registry. United European Gastroenterol J. Published online January 29, 2024. Source

Key clinical point: Children with eosinophilic esophagitis (EoE) have distinct salivary immunoinflammatory protein profiles compared with those without EoE, highlighting the diagnostic potential of salivary proteins in pediatric EoE.

Major finding: Children with EoE were distinguished from those without EoE through a panel of 10 proteins (higher expression levels of C-C motif chemokine-3, macrophage metalloelastase, granulocyte colony-stimulating factor-3, interleukin [IL]-15, pro-transforming growth factor alpha, and oncostatin-M and lower expression levels of IL-18, C-C motif chemokine-2, interstitial collagenase, and macrophage colony-stimulating factor-1), with an accuracy of 0.95 validated through the Least Absolute Shrinkage and Selection Operator regression.

Study details: This cross-sectional study analyzed the saliva samples collected from 40 children aged 6-18 years with (n = 23) or without EoE (n = 17) immediately before their scheduled esophagogastroduodenoscopy with biopsies.

Disclosures: Girish Hiremath and Seesandra V Rajagopala were supported by grants from the US National Institutes of Health. The former declared serving as a consultant for and receiving speaker fees from various organizations.

Source: Hiremath G, Wang Y, Correa H, Sheng Q, Rajagopala SV. Salivary immunoinflammatory proteins identify children with eosinophilic esophagitis. Allergy. 2024 (Jan 29). doi: 10.1111/all.16040 Source

Key clinical point: Children with eosinophilic esophagitis (EoE) have distinct salivary immunoinflammatory protein profiles compared with those without EoE, highlighting the diagnostic potential of salivary proteins in pediatric EoE.

Major finding: Children with EoE were distinguished from those without EoE through a panel of 10 proteins (higher expression levels of C-C motif chemokine-3, macrophage metalloelastase, granulocyte colony-stimulating factor-3, interleukin [IL]-15, pro-transforming growth factor alpha, and oncostatin-M and lower expression levels of IL-18, C-C motif chemokine-2, interstitial collagenase, and macrophage colony-stimulating factor-1), with an accuracy of 0.95 validated through the Least Absolute Shrinkage and Selection Operator regression.

Study details: This cross-sectional study analyzed the saliva samples collected from 40 children aged 6-18 years with (n = 23) or without EoE (n = 17) immediately before their scheduled esophagogastroduodenoscopy with biopsies.

Disclosures: Girish Hiremath and Seesandra V Rajagopala were supported by grants from the US National Institutes of Health. The former declared serving as a consultant for and receiving speaker fees from various organizations.

Source: Hiremath G, Wang Y, Correa H, Sheng Q, Rajagopala SV. Salivary immunoinflammatory proteins identify children with eosinophilic esophagitis. Allergy. 2024 (Jan 29). doi: 10.1111/all.16040 Source

Key clinical point: Children with eosinophilic esophagitis (EoE) have distinct salivary immunoinflammatory protein profiles compared with those without EoE, highlighting the diagnostic potential of salivary proteins in pediatric EoE.

Major finding: Children with EoE were distinguished from those without EoE through a panel of 10 proteins (higher expression levels of C-C motif chemokine-3, macrophage metalloelastase, granulocyte colony-stimulating factor-3, interleukin [IL]-15, pro-transforming growth factor alpha, and oncostatin-M and lower expression levels of IL-18, C-C motif chemokine-2, interstitial collagenase, and macrophage colony-stimulating factor-1), with an accuracy of 0.95 validated through the Least Absolute Shrinkage and Selection Operator regression.

Study details: This cross-sectional study analyzed the saliva samples collected from 40 children aged 6-18 years with (n = 23) or without EoE (n = 17) immediately before their scheduled esophagogastroduodenoscopy with biopsies.

Disclosures: Girish Hiremath and Seesandra V Rajagopala were supported by grants from the US National Institutes of Health. The former declared serving as a consultant for and receiving speaker fees from various organizations.

Source: Hiremath G, Wang Y, Correa H, Sheng Q, Rajagopala SV. Salivary immunoinflammatory proteins identify children with eosinophilic esophagitis. Allergy. 2024 (Jan 29). doi: 10.1111/all.16040 Source

Key clinical point: Altered eating behaviors, including increased chewing and increased consumption time, observed in children with eosinophilic esophagitis (EoE) correlated with patient-reported symptoms, endoscopic findings, and histologic features.

Major finding: Children with vs without EoE demonstrated more chews per bite and increased consumption time with soft solid (P = .031 and P = .002, respectively), chewable (P = .047 and P = .005, respectively), and hard solid (P = .037 and P = .034, respectively) foods. Increased consumption time significantly correlated with a peak eosinophil count (r 0.42; P = .050) and decreased esophageal distensibility (r −0.82; P < .0001).

Study details: This prospective observational study included 27 children with EoE (age 5-17 years) and 25 control children without EoE who consumed four food items, each representing a different texture (puree, soft solid, chewable, and hard solid).

Disclosures: This study was supported by the 2021 American College of Gastroenterology Clinical Research Award and other sources. The authors declared no conflicts of interest.

Source: Kennedy KV, Umeweni CN, Alston M, et al. Esophageal remodeling correlates with eating behaviors in pediatric eosinophilic esophagitis. Am J Gastroenterol. 2024 (Jan 18). doi: 10.14309/ajg.0000000000002661 Source

Key clinical point: Altered eating behaviors, including increased chewing and increased consumption time, observed in children with eosinophilic esophagitis (EoE) correlated with patient-reported symptoms, endoscopic findings, and histologic features.

Major finding: Children with vs without EoE demonstrated more chews per bite and increased consumption time with soft solid (P = .031 and P = .002, respectively), chewable (P = .047 and P = .005, respectively), and hard solid (P = .037 and P = .034, respectively) foods. Increased consumption time significantly correlated with a peak eosinophil count (r 0.42; P = .050) and decreased esophageal distensibility (r −0.82; P < .0001).

Study details: This prospective observational study included 27 children with EoE (age 5-17 years) and 25 control children without EoE who consumed four food items, each representing a different texture (puree, soft solid, chewable, and hard solid).

Disclosures: This study was supported by the 2021 American College of Gastroenterology Clinical Research Award and other sources. The authors declared no conflicts of interest.

Source: Kennedy KV, Umeweni CN, Alston M, et al. Esophageal remodeling correlates with eating behaviors in pediatric eosinophilic esophagitis. Am J Gastroenterol. 2024 (Jan 18). doi: 10.14309/ajg.0000000000002661 Source

Key clinical point: Altered eating behaviors, including increased chewing and increased consumption time, observed in children with eosinophilic esophagitis (EoE) correlated with patient-reported symptoms, endoscopic findings, and histologic features.

Major finding: Children with vs without EoE demonstrated more chews per bite and increased consumption time with soft solid (P = .031 and P = .002, respectively), chewable (P = .047 and P = .005, respectively), and hard solid (P = .037 and P = .034, respectively) foods. Increased consumption time significantly correlated with a peak eosinophil count (r 0.42; P = .050) and decreased esophageal distensibility (r −0.82; P < .0001).

Study details: This prospective observational study included 27 children with EoE (age 5-17 years) and 25 control children without EoE who consumed four food items, each representing a different texture (puree, soft solid, chewable, and hard solid).

Disclosures: This study was supported by the 2021 American College of Gastroenterology Clinical Research Award and other sources. The authors declared no conflicts of interest.

Source: Kennedy KV, Umeweni CN, Alston M, et al. Esophageal remodeling correlates with eating behaviors in pediatric eosinophilic esophagitis. Am J Gastroenterol. 2024 (Jan 18). doi: 10.14309/ajg.0000000000002661 Source

Key clinical point: Eosinophilic esophagitis (EoE) can be distinguished from eosinophilia caused by inflammatory bowel diseases (IBD) by measuring the expression levels of the major basic protein (MBP) biomarker.

Major finding: The median MBP staining levels were significantly higher in patients with EoE vs those with IBD-associated eosinophilia (52.8 vs 0.2; P < .001). Based on the MBP cutoff point of 3.49 units that distinguished EoE from non-EoE cases, 100% of patients with EoE were MBP positive compared with 3% of patients with IBD-associated eosinophilia (P < .05).

Study details: This retrospective study included 29 patients with EoE, 27 patients with both EoE and IBD, 29 patients with IBD-associated eosinophilia, 30 patients with IBD, and 30 control individuals without either EoE or IBD.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Butzke S, Nasiri-Blomgren S, Corao-Uribe D, He Z, Molle-Rios Z. Major basic protein is a useful marker to distinguish eosinophilic esophagitis from IBD-associated eosinophilia in children. J Pediatr Gastroenterol Nutr. 2024 (Feb 5). doi: 10.1002/jpn3.12143 Source

Key clinical point: Eosinophilic esophagitis (EoE) can be distinguished from eosinophilia caused by inflammatory bowel diseases (IBD) by measuring the expression levels of the major basic protein (MBP) biomarker.

Major finding: The median MBP staining levels were significantly higher in patients with EoE vs those with IBD-associated eosinophilia (52.8 vs 0.2; P < .001). Based on the MBP cutoff point of 3.49 units that distinguished EoE from non-EoE cases, 100% of patients with EoE were MBP positive compared with 3% of patients with IBD-associated eosinophilia (P < .05).

Study details: This retrospective study included 29 patients with EoE, 27 patients with both EoE and IBD, 29 patients with IBD-associated eosinophilia, 30 patients with IBD, and 30 control individuals without either EoE or IBD.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Butzke S, Nasiri-Blomgren S, Corao-Uribe D, He Z, Molle-Rios Z. Major basic protein is a useful marker to distinguish eosinophilic esophagitis from IBD-associated eosinophilia in children. J Pediatr Gastroenterol Nutr. 2024 (Feb 5). doi: 10.1002/jpn3.12143 Source

Key clinical point: Eosinophilic esophagitis (EoE) can be distinguished from eosinophilia caused by inflammatory bowel diseases (IBD) by measuring the expression levels of the major basic protein (MBP) biomarker.

Major finding: The median MBP staining levels were significantly higher in patients with EoE vs those with IBD-associated eosinophilia (52.8 vs 0.2; P < .001). Based on the MBP cutoff point of 3.49 units that distinguished EoE from non-EoE cases, 100% of patients with EoE were MBP positive compared with 3% of patients with IBD-associated eosinophilia (P < .05).

Study details: This retrospective study included 29 patients with EoE, 27 patients with both EoE and IBD, 29 patients with IBD-associated eosinophilia, 30 patients with IBD, and 30 control individuals without either EoE or IBD.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Butzke S, Nasiri-Blomgren S, Corao-Uribe D, He Z, Molle-Rios Z. Major basic protein is a useful marker to distinguish eosinophilic esophagitis from IBD-associated eosinophilia in children. J Pediatr Gastroenterol Nutr. 2024 (Feb 5). doi: 10.1002/jpn3.12143 Source

Key clinical point: Pediatric patients with a more recent diagnosis of eosinophilic esophagitis (EoE) are likely to have a greater psychosocial burden from their condition, with a higher symptom burden score correlating positively with somatic symptom scores and negatively with quality of life (QoL).

Major finding: Compared with patients with longer disease duration (>12 months), those with shorter disease duration (6-12 months) had higher symptom burden (P = .03), somatic symptom (P < .01), and trait anxiety (P < .01) scores. Furthermore, a higher symptom burden was significantly associated with increased somatic symptoms (adjusted β [aβ] 0.34; 95% CI 0.23-0.45) and decreased QoL (aβ −0.42; 95% CI −0.59 to −0.25).

Study details: Findings are from a cross-sectional study including 87 pediatric patients with EoE, of whom 71 patients had longer disease duration.

Disclosures: This study was supported by a grant from the University of California San Diego (USCD) Academic Senate and US National Institutes of Health K24 and partially supported by the UCSD Altman Clinical and Translational Research Institute (ACTRI). The authors declared no conflicts of interest.

Source: Jensen ET, Chaiboonma K, Ayala O, Proia A, Aceves SS. Sleep, anxiety, somatization, quality of life, and resilience in pediatric patients with eosinophilic esophagitis. Clin Transl Gastroenterol. 2024 (Jan 11). Doi: 10.14309/ctg.0000000000000672  Source

Key clinical point: Pediatric patients with a more recent diagnosis of eosinophilic esophagitis (EoE) are likely to have a greater psychosocial burden from their condition, with a higher symptom burden score correlating positively with somatic symptom scores and negatively with quality of life (QoL).

Major finding: Compared with patients with longer disease duration (>12 months), those with shorter disease duration (6-12 months) had higher symptom burden (P = .03), somatic symptom (P < .01), and trait anxiety (P < .01) scores. Furthermore, a higher symptom burden was significantly associated with increased somatic symptoms (adjusted β [aβ] 0.34; 95% CI 0.23-0.45) and decreased QoL (aβ −0.42; 95% CI −0.59 to −0.25).

Study details: Findings are from a cross-sectional study including 87 pediatric patients with EoE, of whom 71 patients had longer disease duration.

Disclosures: This study was supported by a grant from the University of California San Diego (USCD) Academic Senate and US National Institutes of Health K24 and partially supported by the UCSD Altman Clinical and Translational Research Institute (ACTRI). The authors declared no conflicts of interest.

Source: Jensen ET, Chaiboonma K, Ayala O, Proia A, Aceves SS. Sleep, anxiety, somatization, quality of life, and resilience in pediatric patients with eosinophilic esophagitis. Clin Transl Gastroenterol. 2024 (Jan 11). Doi: 10.14309/ctg.0000000000000672  Source

Key clinical point: Pediatric patients with a more recent diagnosis of eosinophilic esophagitis (EoE) are likely to have a greater psychosocial burden from their condition, with a higher symptom burden score correlating positively with somatic symptom scores and negatively with quality of life (QoL).

Major finding: Compared with patients with longer disease duration (>12 months), those with shorter disease duration (6-12 months) had higher symptom burden (P = .03), somatic symptom (P < .01), and trait anxiety (P < .01) scores. Furthermore, a higher symptom burden was significantly associated with increased somatic symptoms (adjusted β [aβ] 0.34; 95% CI 0.23-0.45) and decreased QoL (aβ −0.42; 95% CI −0.59 to −0.25).

Study details: Findings are from a cross-sectional study including 87 pediatric patients with EoE, of whom 71 patients had longer disease duration.

Disclosures: This study was supported by a grant from the University of California San Diego (USCD) Academic Senate and US National Institutes of Health K24 and partially supported by the UCSD Altman Clinical and Translational Research Institute (ACTRI). The authors declared no conflicts of interest.

Source: Jensen ET, Chaiboonma K, Ayala O, Proia A, Aceves SS. Sleep, anxiety, somatization, quality of life, and resilience in pediatric patients with eosinophilic esophagitis. Clin Transl Gastroenterol. 2024 (Jan 11). Doi: 10.14309/ctg.0000000000000672  Source

Key clinical point: Treatment with dupilumab led to histologic remission and clinical benefits in patients with eosinophilic esophagitis (EoE) as early as within 12 weeks.

Major finding: The median composite symptom score reduced from 5.5 to 0 (P = .000488) and the median peak eosinophil counts decreased from 44.5 eosinophils/high‐power field (eos/hpf) to 2 eos/hpf (P = .000977) in patients who received dupilumab for 0-12 weeks. However, there were no significant differences in changes in median composite symptom score (P = .1350) and peak eosinophil count (P = .0746) among patients who received dupilumab between 0-12, 12-24, and >24 weeks.

Study details: This retrospective study included 79 patients with EoE who received dupilumab for a median period of 22.7 weeks, and of whom 12 patients received dupilumab for 0-12 weeks.

Disclosures: This study did not receive any specific funding. The corresponding author J Leung declared serving as a consultant for several sources.

Source: Sia T, Miller A, Bacchus L, et al. Dupilumab improves clinical and histologic features of eosinophilic esophagitis prior to 12 weeks of treatment. Clin Transl Allergy. 2024;14(1):e12333. Doi: 10.1002/clt2.12333 Source

Key clinical point: Treatment with dupilumab led to histologic remission and clinical benefits in patients with eosinophilic esophagitis (EoE) as early as within 12 weeks.

Major finding: The median composite symptom score reduced from 5.5 to 0 (P = .000488) and the median peak eosinophil counts decreased from 44.5 eosinophils/high‐power field (eos/hpf) to 2 eos/hpf (P = .000977) in patients who received dupilumab for 0-12 weeks. However, there were no significant differences in changes in median composite symptom score (P = .1350) and peak eosinophil count (P = .0746) among patients who received dupilumab between 0-12, 12-24, and >24 weeks.

Study details: This retrospective study included 79 patients with EoE who received dupilumab for a median period of 22.7 weeks, and of whom 12 patients received dupilumab for 0-12 weeks.

Disclosures: This study did not receive any specific funding. The corresponding author J Leung declared serving as a consultant for several sources.

Source: Sia T, Miller A, Bacchus L, et al. Dupilumab improves clinical and histologic features of eosinophilic esophagitis prior to 12 weeks of treatment. Clin Transl Allergy. 2024;14(1):e12333. Doi: 10.1002/clt2.12333 Source

Key clinical point: Treatment with dupilumab led to histologic remission and clinical benefits in patients with eosinophilic esophagitis (EoE) as early as within 12 weeks.

Major finding: The median composite symptom score reduced from 5.5 to 0 (P = .000488) and the median peak eosinophil counts decreased from 44.5 eosinophils/high‐power field (eos/hpf) to 2 eos/hpf (P = .000977) in patients who received dupilumab for 0-12 weeks. However, there were no significant differences in changes in median composite symptom score (P = .1350) and peak eosinophil count (P = .0746) among patients who received dupilumab between 0-12, 12-24, and >24 weeks.

Study details: This retrospective study included 79 patients with EoE who received dupilumab for a median period of 22.7 weeks, and of whom 12 patients received dupilumab for 0-12 weeks.

Disclosures: This study did not receive any specific funding. The corresponding author J Leung declared serving as a consultant for several sources.

Source: Sia T, Miller A, Bacchus L, et al. Dupilumab improves clinical and histologic features of eosinophilic esophagitis prior to 12 weeks of treatment. Clin Transl Allergy. 2024;14(1):e12333. Doi: 10.1002/clt2.12333 Source

Key clinical point: Patients diagnosed with both eosinophilic esophagitis (EoE) and inflammatory bowel diseases (IBD), like ulcerative colitis (UC) or Crohn’s disease (CD), are found to be more susceptible to immune-mediated comorbidities and IBD-related conditions but less susceptible to food bolus impaction.

Major finding: The risk for IBD-related complications (adjusted hazard ratio [aHR] > 1.1; P < .05) was higher, whereas the risk for food bolus impaction was lower (aHR 0.445; P  =  .0011), in patients with EoE and a concurrent diagnosis of IBD. The risk for immune-related comorbidities, such as celiac disease, IBD-related inflammatory conditions, eczema, and asthma, was also higher (P < .05) in patients with IBD who did vs did not have EoE.

Study details: Findings are from a retrospective population-based cohort study that included 174,755 patients with CD, 150,774 patients with UC, and 47,615 patients with EoE.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Malik A, Liu BD, Zhu L, Kaelber D, Song G. A comprehensive global population-based analysis on the coexistence of eosinophilic esophagitis and inflammatory bowel disease. Dig Dis Sci. 2024 (Jan 13). doi: 10.1007/s10620-024-08283-2 Source

Key clinical point: Patients diagnosed with both eosinophilic esophagitis (EoE) and inflammatory bowel diseases (IBD), like ulcerative colitis (UC) or Crohn’s disease (CD), are found to be more susceptible to immune-mediated comorbidities and IBD-related conditions but less susceptible to food bolus impaction.

Major finding: The risk for IBD-related complications (adjusted hazard ratio [aHR] > 1.1; P < .05) was higher, whereas the risk for food bolus impaction was lower (aHR 0.445; P  =  .0011), in patients with EoE and a concurrent diagnosis of IBD. The risk for immune-related comorbidities, such as celiac disease, IBD-related inflammatory conditions, eczema, and asthma, was also higher (P < .05) in patients with IBD who did vs did not have EoE.

Study details: Findings are from a retrospective population-based cohort study that included 174,755 patients with CD, 150,774 patients with UC, and 47,615 patients with EoE.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Malik A, Liu BD, Zhu L, Kaelber D, Song G. A comprehensive global population-based analysis on the coexistence of eosinophilic esophagitis and inflammatory bowel disease. Dig Dis Sci. 2024 (Jan 13). doi: 10.1007/s10620-024-08283-2 Source

Key clinical point: Patients diagnosed with both eosinophilic esophagitis (EoE) and inflammatory bowel diseases (IBD), like ulcerative colitis (UC) or Crohn’s disease (CD), are found to be more susceptible to immune-mediated comorbidities and IBD-related conditions but less susceptible to food bolus impaction.

Major finding: The risk for IBD-related complications (adjusted hazard ratio [aHR] > 1.1; P < .05) was higher, whereas the risk for food bolus impaction was lower (aHR 0.445; P  =  .0011), in patients with EoE and a concurrent diagnosis of IBD. The risk for immune-related comorbidities, such as celiac disease, IBD-related inflammatory conditions, eczema, and asthma, was also higher (P < .05) in patients with IBD who did vs did not have EoE.

Study details: Findings are from a retrospective population-based cohort study that included 174,755 patients with CD, 150,774 patients with UC, and 47,615 patients with EoE.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Malik A, Liu BD, Zhu L, Kaelber D, Song G. A comprehensive global population-based analysis on the coexistence of eosinophilic esophagitis and inflammatory bowel disease. Dig Dis Sci. 2024 (Jan 13). doi: 10.1007/s10620-024-08283-2 Source

Key clinical point: A twice-daily moderate proton pump inhibitor (PPI) dose (20 mg omeprazole twice daily) induced greater histologic response rates in patients with eosinophilic esophagitis (EoE) than a once-daily moderate PPI dose (40 mg once daily), regardless of the total daily dosage.

Major finding: The rate of histologic remission significantly improved with twice-daily moderate vs once-daily moderate PPI dose (52.8% vs 10.0%; P < .0001). Compared with a standard PPI dose (20 mg omeprazole once daily), twice-daily moderate (adjusted odds ratio [aOR] 6.75; P = .0008) and high (40 mg omeprazole twice daily; aOR 12.8; P < .0001) PPI doses were associated with increased odds of histologic response.

Study details: This retrospective cohort study included 305 newly diagnosed patients with EoE who received standard, once-daily moderate, twice-daily moderate, or high PPI doses for more than 8 weeks.

Disclosures: This study did not disclose the source of any funding. Walter W. Chan declared serving on scientific advisory boards for various organizations, including Sanofi and Regeneron Pharmaceuticals.

Source: Muftah M, Goldin AH, Barshop K, et al. Twice daily PPI induces higher remission rate in eosinophilic esophagitis than once daily regimen regardless of total daily dose. Am J Gastroenterol. 2024 (Feb 5). doi: 10.14309/ajg.0000000000002712  Source

Key clinical point: A twice-daily moderate proton pump inhibitor (PPI) dose (20 mg omeprazole twice daily) induced greater histologic response rates in patients with eosinophilic esophagitis (EoE) than a once-daily moderate PPI dose (40 mg once daily), regardless of the total daily dosage.

Major finding: The rate of histologic remission significantly improved with twice-daily moderate vs once-daily moderate PPI dose (52.8% vs 10.0%; P < .0001). Compared with a standard PPI dose (20 mg omeprazole once daily), twice-daily moderate (adjusted odds ratio [aOR] 6.75; P = .0008) and high (40 mg omeprazole twice daily; aOR 12.8; P < .0001) PPI doses were associated with increased odds of histologic response.

Study details: This retrospective cohort study included 305 newly diagnosed patients with EoE who received standard, once-daily moderate, twice-daily moderate, or high PPI doses for more than 8 weeks.

Disclosures: This study did not disclose the source of any funding. Walter W. Chan declared serving on scientific advisory boards for various organizations, including Sanofi and Regeneron Pharmaceuticals.

Source: Muftah M, Goldin AH, Barshop K, et al. Twice daily PPI induces higher remission rate in eosinophilic esophagitis than once daily regimen regardless of total daily dose. Am J Gastroenterol. 2024 (Feb 5). doi: 10.14309/ajg.0000000000002712  Source

Key clinical point: A twice-daily moderate proton pump inhibitor (PPI) dose (20 mg omeprazole twice daily) induced greater histologic response rates in patients with eosinophilic esophagitis (EoE) than a once-daily moderate PPI dose (40 mg once daily), regardless of the total daily dosage.

Major finding: The rate of histologic remission significantly improved with twice-daily moderate vs once-daily moderate PPI dose (52.8% vs 10.0%; P < .0001). Compared with a standard PPI dose (20 mg omeprazole once daily), twice-daily moderate (adjusted odds ratio [aOR] 6.75; P = .0008) and high (40 mg omeprazole twice daily; aOR 12.8; P < .0001) PPI doses were associated with increased odds of histologic response.

Study details: This retrospective cohort study included 305 newly diagnosed patients with EoE who received standard, once-daily moderate, twice-daily moderate, or high PPI doses for more than 8 weeks.

Disclosures: This study did not disclose the source of any funding. Walter W. Chan declared serving on scientific advisory boards for various organizations, including Sanofi and Regeneron Pharmaceuticals.

Source: Muftah M, Goldin AH, Barshop K, et al. Twice daily PPI induces higher remission rate in eosinophilic esophagitis than once daily regimen regardless of total daily dose. Am J Gastroenterol. 2024 (Feb 5). doi: 10.14309/ajg.0000000000002712  Source