EoE Module 10 References-Eluri et al Clin Gastroenterol Hepatol 2019 Clinical and Molecular Factors Associated With Histologic Response to Topical Steroid Treatment EoE

Eluri et al Clin Gastroenterol Hepatol 2019 Clinical and Molecular Factors Associated With Histologic Response to Topical Steroid Treatment EoE

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The study aimed to identify predictors of histologic response to topical steroid treatment in patients with eosinophilic esophagitis (EoE). Over 97 patients were analyzed, examining clinical, endoscopic, histologic, and molecular characteristics to foresee treatment outcomes. Primary consideration was to distinguish factors that predict complete histologic response, defined as having fewer than 1 eosinophil per high-power field (1 eos/hpf) post-treatment.<br /><br />The study found that baseline need for esophageal dilation was a predictor of non-response at the standard threshold of 15 eos/hpf. Other potential predictors, modeled through an alternative definition of complete response (1 eos/hpf) versus non-response (50% reduction in baseline eosinophil count), identified that older age and food allergies were linked to positive treatment outcomes. In contrast, variables like the need for dilation, edema presence, and hiatal hernia predicted non-response.<br /><br />Importantly, baseline gene expression patterns failed to predict treatment response, suggesting that molecular markers did not significantly influence patient outcomes at any threshold analyzed. This study reinforces the challenge of identifying reliable predictors with strict eosinophil-based response definitions.<br /><br />Ultimately, the results highlight the histological complexity and varied responses of EoE to steroid treatments. The findings support utilizing a model with clinical features to tailor treatment plans, thereby integrating these predictors into clinical practice to preemptively identify patients less likely to benefit from topical steroids, suggesting they may need alternative therapies. The study underscores the need for nuanced response definitions in EoE treatment evaluation and encourages further research to establish predictive tools aiding effective, personalized patient care.

Keywords

eosinophilic esophagitis

topical steroid treatment

histologic response

predictors

treatment outcomes

clinical characteristics

gene expression

non-response

personalized care

alternative therapies