EndoFLIP distensibility index correlates with histologic findings in children with eosinophilic esophagitis

The Eosinophilic Esophagitis Histology Scoring System (EoEHSS) is useful for diagnosing and characterizing eosinophilic esophagitis (EoE). A limitation of the EoEHSS is that lamina propria fibrosis scores are infrequently determined due to challenges in sampling lamina propria. Low distensibility index (DI) measured by endoluminal functional lumen imaging probe (EndoFLIP) is associated with fibrostenotic severity in pediatric patients with EoE. We investigated the correlation between DI and the EoEHSS to understand whether EndoFLIP could be a useful complementary tool for evaluating EoE-associated remodeling in children.

We reviewed the medical records of patients <21 years of age who underwent an esophagogastroduodenoscopy (EGD) with biopsy and EndoFLIP between October 2017 and July 2023 with histologic diagnoses of normal/reactive, reflux, or EoE. EoEHSS scores and luminal parameters were compared between groups. DI measured at 30 mL inflation was compared with EoEHSS scores.

One hundred twenty-six EGDs with biopsy and EndoFLIP were performed on 112 patients. There were 80 normal/reactive, 32 reflux, and 14 EoE biopsies. At 30 mL inflation, DI was lowest in the EoE group (p = 0.03). DI at 30 mL inflation negatively correlated with the EoEHSS overall grade score, as well as grade and stage scores for eosinophil abscesses, eosinophil surface layering, dilated intercellular spaces, and basal zone hyperplasia (all p < 0.05). DI at 30 mL inflation also negatively correlated with the eosinophilic inflammation stage score (p < 0.05).

DI measured by EndoFLIP at 30 mL inflation shows a negative correlation with composite EoEHSS scores and subscores, suggestive of remodeling. EndoFLIP may complement the EoEHSS in evaluating EoE-associated esophageal remodeling.