ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2026
Diffuse esophageal eosinophilia is associated with increased endoscopic severity and topical steroid non-response in patients with eosinophilic esophagitis.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsVariability of esophageal eosinophil distributions and its impact on disease presentation and treatment outcomes in eosinophilic esophagitis (EoE) is unclear. We aimed to determine whether isolated proximal or distal involvement differs from diffuse involvement in EoE presentation and treatment outcomes.
methodsThis retrospective cohort study analyzed patients of all ages with newly diagnosed EoE from the UNC EoE Clinicopathologic database. Patients were classified as distal esophagus-only (≥15 eos/hpf), proximal-only (≥15 eos/hpf), and diffuse involvement (≥15 eos/hpf in both regions). Outcomes included histologic response (<15, ≤6, and <1 eos/hpf), global symptomatic response, and endoscopic response after treatment. Baseline characteristics and post-treatment response were compared between patients with localized and diffuse eosinophil involvement.
resultsOf 888 cases of EoE, eosinophil counts were higher in the distal (54.8±44.7) versus proximal esophagus (44.0±40.1; p<0.001). Diffuse involvement (n=623; 70%) was associated with more inflammatory endoscopic findings and higher mean EREFS (4.0±1.8, p<0.001) compared to those with proximal (2.8±1.8) and distal involvement (2.7±1.6). Strictures and worse disease severity (Index of Severity for EoE) were also more frequent in diffuse disease. After topical corticosteroid treatment (n=395), patients with diffuse disease had reduced histologic response (at all thresholds) and endoscopic response compared to those with localized disease.
conclusionsEoE patients with diffuse esophageal eosinophilic involvement had greater baseline disease severity and decreased histologic and endoscopic treatment response to topical corticosteroids than those with localized disease. Diffuse disease involvement could be an important marker for risk stratification and therapeutic decision-making in EoE disease management.
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