Researchers from Children’s Hospital of Philadelphia (CHOP) and Children’s Hospital Colorado have conducted the first prospective study tracking pediatric patients with eosinophilic esophagitis (EoE) over time to better understand disease progression. Their findings indicate that improved control of EoE-associated inflammation in children leads to less stiffening of the esophagus, which results in fewer complications related to the disease. The study used Endoluminal functional imaging (FLIP) as a tool for assessing disease severity and progression, and was published online by the journal Gastroenterology.
EoE is a chronic allergic inflammatory condition affecting the esophagus, which can cause symptoms such as nausea, regurgitation, vomiting, abdominal pain, heartburn-like discomfort, difficulty swallowing, frequent gagging, and a sensation of food being stuck in the throat (dysphagia). If left untreated, EoE may result in narrowing of the esophagus due to scarring—a condition known as stricture.
Chronic inflammation associated with EoE can lead to tissue remodeling and fibrostenosis (narrowing of the esophagus). Despite recognition of its seriousness among clinicians, there has been limited research into long-term outcomes or how early disease control impacts progression.
“This is the first study to follow kids overtime with these endoscopic assessments and evaluate the patients who are at the highest risk of complications,” said co-senior study author Amanda Muir, MD, a pediatric gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at CHOP. “With the recent FDA approval of two medications for EoE, having this data could help identify the patients who could benefit from these therapies the most and observe improvement at a histologic level over time.”
The research involved a longitudinal approach examining changes in esophageal distensibility—the ability of the esophagus to expand—in children aged 3 to 18 years old diagnosed with EoE. Data were collected during each visit on symptoms, endoscopic findings, and tissue samples. The study included 112 participants with a median follow-up period of 11 months; some were followed for more than four years.
“Following children living with EoE over time has given us a clearer picture of how inflammation affects the esophagus and how treating it can improve the esophagus and outcomes for patients,” said Calies Menard-Katcher, MD, co-senior study author and Associate Director of Clinical Research for the Gastrointestinal Eosinophilic Diseases Program at Children’s Hospital Colorado. “It’s exciting to see these results confirm what we’ve suspected in caring for patients — and they may even help us spot those at risk for more severe disease.”
Results showed that children whose tissue samples responded well to treatment experienced greater improvement in esophageal flexibility over time. After accounting for various factors, lower distensibility was linked with increased odds of patient-reported difficulty swallowing. Those with fibrostenosis tended to be older at diagnosis, had longer-standing disease history, and exhibited reduced flexibility in their esophagus.
Baseline measurements also helped predict which patients might require future dilation procedures due to strictures.
The authors recommend additional studies focusing on molecular aspects of EoE to identify which children face higher risks for severe forms of disease so that tailored treatments can be developed.
This research received support from National Institutes of Health grants R01DK124266-01, K23DK109263 and R21TR003039.
Kennedy et al., “Histologic response is associated with improved esophageal distensibility and symptom burden in pediatric eosinophilic esophagitis.” Gastroenterology. Online August 15, 2025. DOI: 10.1053/j.gastro.2025.07.042.
