An immune-mediated inflammatory condition known as eosinophilic esophagitis (EoE) is characterized by eosinophilic infiltration of esophageal tissue. Predicting therapy response may be possible for EoE patients based on their subtyping. Researchers suggested clinical subgroups, retroactively applied them to the pediatric EoE cohort, and evaluate treatment options and remission at one year.

Retrospective chart reviews of children with EoE diagnoses were done. Based on their presenting features, patients were divided into the suggested subgroups (severe, allergic, fibrostenotic, inflammatory, and unclassified). Histologic remission, which was determined to be 15 eosinophils/high-powered-field (hpf) at the last visit 1 year after diagnosis, was the main result.

Out of 256 patients, 242 could be subtyped, and 75 had follow-up histology data available. The bulk of the cohort had the same phenotype, with 17% of cases being categorized as severe, 77% as allergic, 15% as fibrostenotic, 60% as inflammatory, and 5% as unclassified, while 45% were given a specific subtype. At 1 year, 43/75 (57%) of the patients had histologic remission, and the average number of eosinophils/hpf had decreased across the board by 33 (IQR: 47–12). The rates of remission among the various subtypes were the same. First-line therapy review revealed higher rates of proton pump inhibitor (PPI) ± topical steroids utilization in severe patients, whereas, in the fibrostenotic subtype, topical steroids were administered more frequently than nutritional treatment.

Clinically defined subtypes of EoE did not show any observable differences in remission rates at 1 year, albeit this might be related to subtype overlap. Medical treatment was generally well received by patients. Larger prospective trials aimed at subtyping individuals and standardizing care may aid in individualized EoE therapy.

Reference: journals.lww.com/jpgn/Abstract/2022/10000/Subtyping_of_Eosinophilic_Esophagitis_Based_on.20.aspx