Su1870 Serial Endoscopy in Eosinophilic Esophagitis: Treat & Titrate or Treat & Leave Alone?

Abstract

Background: Current guidelines have confirmed endoscopy and eosinophil count on biopsy as the key to diagnosis of eosinophilic esophagitis (EoE). However, it is unclear if treatment endpoints of EoE should rely on symptoms, eosinophil count, or both. Aim: This study seeks to determine the outcomes of histology-driven treatment decisions in EoE, as obtained from endoscopic biopsies. Methods: This is a retrospective cohort study of 156 adult patients diagnosed with EoE or noted to have eosinophils on esophageal biopsy. Symptoms of dysphagia, dyspepsia, impaction, regurgitation and chest pain were graded based on frequency and used to calculate a total symptom score. Biopsy reports were examined for the peak eosinophil count per high-powered field (eos/hpf). Symptom score and peak eosinophil count were re-examined after a new therapy regimen, including topical steroids, 6-food elimination diet, and allergy directed elimination diet. Patients were excluded if they were found to have PPI-responsive eosinophilia or if there was no post-treatment endoscopy. Pre and post-treatment symptom score and eos/hpf were analyzed with the Wilcoxon signedrank test to assess for difference. The Spearman's rank correlation was utilized to determine the relationship between the change in eosinophil count and change in symptom score. Results: Of 156 patients, 41 met criteria for the study. Symptoms improved, stayed the same, or worsened in 71%, 12% and 17% of patients respectively. Eosinophil count decreased in 78% and increased in 22% of patients. The median symptom score decreased from 4 to 2 points (p,0.001). The median peak eosinophil count decreased from 46 to 13 (p,0.001). The Spearman correlation coefficient between the change in symptom score and eosinophil count was 0.377 (p = 0.015) (see Figure 1). Conclusion: A change in symptom score was associated with a weak but statistically significant change in peak eosinophil count after treatments for EoE. While decreasing symptoms suggest an improving histologic profile, the ability to titrate treatment and modify outcome by following symptoms merits further investigation.