Untreated eosinophilic esophagitis (EoE) can result in the development of fibrostenosis over time, but there are few data on whether successful treatment in childhood decreases this risk as children with EoE transition to adulthood. To determine whether histologic response or endoscopic normalization after EoE treatment is associated with decreased development of fibrostenosis. Pediatric subjects were identified from a large EoE database at an academic referral center. Medical records were reviewed for the primary outcome of fibrostenosis, defined as esophageal stricture, narrowing, or dilation. We assessed the proportion of histologic responders and normal endoscopies at the first, second, and last esophagogastroduodenoscopy (EGD) on record following diagnosis. We created Kaplan–Meier curves to assess time to fibrostenosis and estimated hazard ratios using Cox proportional analysis. Among 166 patients, the mean age at diagnosis was 10.2 years. Over a mean follow-up time of 4.7 ± 4.5 years, patients had an average of 4.3 ± 4.2 EGDs. The percent of patients with fibrostenosis was 9

Cannabis use is becoming increasingly common, both for recreational and medical purposes. However, there is a paucity of data regarding cannabis use in the context of eosinophilic esophagitis (EoE). We aimed to determine the impact of cannabis use on presentation and treatment response in EoE. To this end, we conducted a retrospective cohort study at a large academic medical center of newly diagnosed EoE patients age ≥ 12 years. Self-reported cannabis use status, baseline characteristics, and treatment response to topical corticosteroids and dietary therapy data were extracted. Bivariate and multivariable analyses were used to compare cannabis users and non-users at time of EoE diagnosis and to assess treatment response. Of 983 EoE patients, 80 reported using cannabis, with the majority reporting daily use and administration by inhalation. Baseline symptoms and peak eosinophil count were similar between cannabis users and non-users; cannabis users were less likely to have baseline endoscopic findings of exudates, edema, and stricture, and lower total Endoscopic Reference Score. On multivariable analysis, younger age, male sex, non-White race, and psychiatric diagnosis were independently associated with history of cannabis use at EoE presentation and stricture was independently associated with cannabis non-use. Post-treatment symptom and histologic responses were similar between cannabis users and non-users though there was a higher odds of post-treatment endoscopic inflammatory features with cannabis use. In conclusion, despite presenting with milder initial endoscopic findings, cannabis users exhibited greater inflammatory findings after treatment, highlighting a potential negative influence of cannabis use on EoE management.

Background and Aims:Dietary therapy is a first-line treatment for eosinophilic esophagitis (EoE). We aimed to determine whether dietary therapy treatment outcomes vary by baseline weight status or change in body weight during treatment. Methods:In this retrospective analysis of adults with EoE treated with dietary therapy from a large academic center, we assessed the relationships of baseline weight status and change in body weight on histologic, endoscopic, and symptom responses using bivariate and multivariable analyses. Results:Of 170 identified adults with EoE treated with dietary therapy, 37% had histologic, 56% endoscopic, and 66% symptom responses. Treatment outcomes to dietary therapy were not statistically significantly different between adults with overweight or obesity and healthy weight. However, compared to those with no weight gain, weight gain during dietary therapy was associated with lower histologic (17% vs 51%, P < .001), endoscopic (43% vs 65%, P = .004), and symptom (53% vs 75%, P = .004) responses. On multivariable logistic regression, a 1% increase in body weight was associated with a 22% decrease in histologic response (adjusted odds ratio [aOR] 0.78; 95% confidence interval [CI] 0.69-0.89) after accounting for baseline Eosinophilic Esophagitis Endoscopic Reference Score and concomitant medication therapy, an 8% decrease in endoscopic response (aOR 0.93; 95% CI 0.85-1.00) after accounting for baseline Eosinophilic Esophagitis Endoscopic Reference Score, and a 16% decrease in symptom response (aOR 0.84; 95% CI 0.78-0.91) after accounting for prior food impaction and concomitant medication therapy. Conclusion:Weight gain during EoE dietary therapy may hinder treatment success, irrespective of initial weight status. We recommend offering dietary therapy to EoE patients who express interest, regardless of their initial weight status, monitoring adherence, and addressing weight changes during treatment.

BACKGROUND & AIMS: Few data compare topical corticosteroid (tCS) dosing regimens and outcomes. We aimed to compare treatment outcomes in patients with eosinophilic esophagitis (EoE) by once or twice daily dosing regimens. METHODS: We conducted a retrospective cohort study using the UNC EoE Clinicopathologic Database of newly diagnosed patients with EoE treated with a tCS who had a follow-up endoscopy with biopsy. Baseline data and outcomes were extracted. Bivariate and multivariate analyses compared patients at baseline and following initial tCS given as a once or twice daily dose. RESULTS: A total of 522 patients met inclusion criteria, 122 patients on once daily dosing (72% male; 91% white) and 400 patients on twice daily dosing (66% male; 89% white). Patients on twice daily dosing were older (28.8 +/- 18.2 vs 24.3 +/- 18.0; P = .01) and reported more heartburn (40% vs 25%; P = .004). On bivariate analysis, global symptomatic response (78% vs 76%; P = .82), posttreatment eosinophil count (20.8 +/- 27.2 vs 25.6 +/- 39.4; P = .21), posttreatment EoE Endoscopic Reference Score (2.2 +/- 1.8 vs 2.2 +/- 2.0; P = .92), and histologic response (<15 eos/hpf; 56% vs 58%; P = .66) did not differ by dosing frequency. Candida was less frequent with daily dosing (2% vs 8%; P = .04). In multivariate analysis, the odds of histologic response did not differ by dose groups (adjusted odds ratio, 1.03; 95% confidence interval, 0.67-1.60). CONCLUSIONS: EoE outcomes did not differ by daily or twice daily dosing regimens. These results inform tCS dosing regimens and reassure that both are effective.

Predicting fibrostenotic complications prior to endoscopy in eosinophilic esophagitis (EoE) is challenging and esophageal strictures and narrowing are commonly missed on endoscopy. To develop and validate a score to predict fibrostenosis in EoE patients prior to endoscopy. We leveraged a large database of newly diagnosed EoE patients. Fibrostenosis was defined as esophageal stricture, luminal narrowing, or dilation performed during the diagnostic endoscopy. Patients were randomly divided into a development and validation set. We compared features between patients with and without fibrostenosis to inform the initial model and assess predictive ability, as measured by area under curve (AUC). We tested the model in the independent validation set and generated a score to predict low, medium and high fibrostenosis risk. In 655 newly diagnosed EoE patients in the development set, fibrostenosis was associated with age ≥ 18 years (OR 10.64; 95

Objective We aimed to determine whether mepolizumab, an anti-IL- 5 antibody, was more effective than placebo for improving dysphagia symptoms and decreasing oesophageal eosinophil counts in eosinophilic oesophagitis (EoE). Methods We conducted a multicentre, randomised, double-blind, placebo-controlled, trial. In the first part, patients aged 16-75 with EoE and dysphagia symptoms (per EoE Symptom Activity Index (EEsAI)) were randomised 1:1 to 3 months of mepolizumab 300 mg monthly or placebo. Primary outcome was change in EEsAI from baseline to month 3 (M3). Secondary outcomes included histological, endoscopic and safety metrics. In part 2, patients initially randomised to mepolizumab continued 300 mg monthly for 3 additional months (mepo/mepo), placebo patients started mepolizumab 100 mg monthly (pbo/mepo), and outcomes were reassessed at month 6 (M6). Results Of 66 patients randomised, 64 completed M3, and 56 completed M6. At M3, EEsAI decreased 15.4 +/- 18.1 with mepolizumab and 8.3 +/- 18.0 with placebo (p=0.14). Peak eosinophil counts decreased more with mepolizumab (113 +/- 77 to 36 +/- 43) than placebo (146 +/- 94 to 160 +/- 133) (p<0.001). With mepolizumab, 42% and 34% achieved histological responses of <15 and =6 eos/hpf compared with 3% and 3% with placebo (p<0.001 and 0.02). The change in EoE Endoscopic Reference Score at M3 was also larger with mepolizumab. At M6, EEsAI decreased 18.3 +/- 18.1 points for mepo/mepo and 18.6 +/- 19.2 for pbo/mepo (p=0.85). The most common adverse events were injection-site reactions. Conclusions Mepolizumab did not achieve the primary endpoint of improving dysphagia symptoms compared with placebo. While eosinophil counts and endoscopic severity improved with mepolizumab at 3 months, longer treatment did not yield additional improvement.