D3.23 - Descriptive and Comparative Analysis of Clinical and Endoscopic Characteristics and Treatment Response in Adult Patients with Eosinophilic Esophagitis (EoE): a preliminary experience of an Italian centre

Eosinophilic esophagitis (EoE) is a chronic Th2-mediated inflammatory disease, with an increasing incidence in recent years. This study aims is to describe an Italian cohort of EoE patients, analyzing clinical and endoscopic features, allergenic sensitization profile, association with other atopic diseases and treatment responses.

Clinical history, spirometry, skin prick tests,laboratory and EGD data and gastroenterology consultations of 19 patients were collected. Patients were grouped by therapy (PPI, oral budesonide, Dupilumab) and response was assessed endoscopically, histologically, through questionnaires on symptoms and quality of life (DSQ, EoEIQ).

Most patients were male (73.7%), with a median age of 37 years and a disease duration of 5 years. Common comorbidities included food allergies (57.9%), inhalant allergies (73.7%), atopic dermatitis (27%), and allergic rhinitis (21%). 15.8% of patients had asthma according to ATS/ERS criteria. At diagnosis, median blood eosinophil count was 450 cells/mcl (IQR 208-615) and total IgE was 282 KU/l (IQR 159-1046). Endoscopy at the diagnosis showed predominantly mixed inflammatory-stenotic features in 52.9%, followed by inflammatory with edema and exudate (23.5%), and fibrotic pattern (23.5%). Food allergies were more common in those with a baseline mixed pattern, followed by those with an inflammatory pattern, and lastly in stenotic. Significant differences were observed in eosinophil count/HPF between stenotic pattern (median 16 EOS/HPF, IQR 16-18,3) and mixed pattern (median 35 EOS/HPF, IQR 26,3-60). Atopic dermatitis and asthma were more often associated with mixed patterns and higher baseline EREFS scores, correlating with a more severe endoscopic presentation. At the follow up after 10 months, those treated with Dupilumab showed a normal endoscopy, while PPI-treated patients had persistent mixed pattern. The score of validated questionnaires (EoEIQ, DSQ) decreased after treatment in all groups, alongside reductions in peripheral eosinophils, EOS/HPF, and EREFS.

Our study confirms the strong association between Th2-mediated comorbidities and EoE, affecting young allergic predisposed males. Our first findings suggests that asthma, atopic dermatitis, food allergies are linked to more severe, mixed endoscopic patterns. Dupilumab treatment showed promising results, with 66.7% of patients achieving normal endoscopic findings.