Distal Esophageal Wall Thickness in EoE Independent of Dysphagia Score, Eosinophil Count


Investigators wanted to assess endoscopic appearance, wall thickness, histology, and dysphagia score for eosinophilic esophagitis (EoE).

Patients who have eosinophilic esophagitis (EoE) developed greater thickness in their distal esophageal wall, and this was shown to be independent of their dysphagia score and eosinophil count, according to study findings published in Journal of Gastroenterology and Hepatology.

The study took place at the Royal Adelaide Hospital in Adelaide, South Australia, and EoE was defined as comprising 15 or more eosinophils/hpf and symptoms of esophageal dysfunction. Patients (N = 16) were enrolled between February 2012 and April 2021 via an invitation letter or their data were retrieved from an existing database or they were invited to participate at an outpatient clinic/endoscopy appointment. They were evaluated for frequency and intensity of dysphagia in an initial analysis and invited to a follow-up endoscopy and mucosal biopsies at least 1 year after their initial assessment.

Patients’ median (IQR) age was 43.5 (28) years at the initial assessment and 45.4 (60.5) years at the follow-up, the median disease duration was 2.5 (7) years, and 83% were declared refractory to therapy at baseline. All participants underwent endoscopic ultrasound (EUS) and mucosal biopsies and completed a dysphagia score.

“Studies using EUS studies in EoE patients have been able demonstrate significant thickening of the esophagealwallduetothisremodelingprocess,” the study authors wrote. “We therefore hypothesized that the esophageal wall thickness in EoE increases with time and can be detected using EUS.”

Overall, the median endoscopic reference score was 2.5 (2.75) at the initial assessment and 3.0 (2.75) at the follow-up (P = .5805). Within this score, totals for fixed rings and for white plaques rose from 12 to 14 and 7 to 8, respectively, while for longitudinal furrows, the total dropped from 15 to 13.

Peak eosinophil counts also rose across the board from initial assessment to follow-up for mean measures take from the proximal, mid, and distal esophageal walls: 18 (25.5) to 22.5 (25.0), 25.0 (19.5) to 25.5 (24.0), and 23.5 (16.0) to 30.0 (37.5) eosinophils/hpf, respectively.

Mean (SD) overall follow-up was 2.2 (1.2) years.

Eighty-eight percent of patients saw the total thickness of their distal esophageal wall increase over the mean follow-up period, with the primary cause being thickening of the muscularis propria layer (P = .0218). The total thickness came in at 5.6 (2.0) mm at the follow-up compared with 2.85 (1.65) mm seen at the initial assessment (P = .0012), and that for the muscularis propria, 2.4 (0.8) vs 1.3 (1.3) mm, respectively (P = .0218). These findings were considered statistically significant.

Among this group, 64% had persistent dysphagia but only 1 patient had a higher dysphagia score at the follow-up. Further, a reduction in dysphagia score was only seen in 36% of those who had an increase in wall thickness.

Only one other result was considered statistically significant. The measure taken for the muscularis propria at the mid esophageal wall showed thickness increasing from 1.3 (1.2) to 1.7 (1.1) mm from initial assessment to follow-up (P = .0259).

For the proximal esophageal wall, thickness changes overall (P = .055) and for the muscularis propria (P = .8955), submucosa (P = .5567), and mucosa (P = .6452) were not deemed statistically significant, nor were mid esophageal wall measures for overall (P = .0542) and the submucosa (P = .4888) and mucosa (P = .9510). And for the distal esophageal wall, findings on thickness changes to the submucosa (P = .5711) and mucosa (P = .6470) were not statistically significant.

Further, significant correlations were not seen between dysphagia score and proximal, mid, and esophageal wall thickness at follow-up, nor between change in dysphagia score and distal esophageal wall thickness.

“The strength of our study is that it is a comprehensive lo-gitudinal study assessing esophageal wall thickness in adult EoE patients,” the study authors concluded. “The main limitation of our study is the small sample size where type II errors may occur.”

Because of this conflict, they recommend larger studies to confirm their findings and how they may affect clinical management of patients who have EoE.


Wong S, Safaeian R, Zobel J, Holloway RH, Ruszkiewicz A, Nguyen NQ. Increase of distal esophageal wall thickness with time in adult patients with eosinophilic esophagitis. JGH Open. 2023;7(3):178-181. doi:10.1002/jgh3.12866

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