ETD

• biomarkers
• dysphagia
• EoE

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease marked by esophageal dysfunction and eosinophil-predominant inflammation. Its rising incidence increases healthcare burden due to repeated endoscopies, highlighting the need for non-invasive biomarkers. This study assessed clinical, behavioral, blood, and serum markers in 343 patients.

Clinical and behavioral measures were analyzed in 95 patients (56 active, 39 remission). Dysphagia scores (mDSQ, DSS) were higher in active EoE and strongly correlated. Anxiety, hypervigilance, and adaptive behaviors (slow chewing, cutting food, drinking fluids) were also more common. Dysphagia scores alone predicted histologic activity (AUROC 75–78%), adaptive behaviors reached 78%, while anxiety/hypervigilance were weaker. Combining symptoms with psychological and behavioral metrics improved accuracy to 84–87%, showing the added value of adaptive behaviors.

Peripheral eosinophils were evaluated in 209 patients (123 EoE, 86 non-EoE dysphagia). Active EoE showed higher absolute eosinophil counts (AEC). A threshold of 155 cells/mm³ yielded AUROC 85% (87% sensitivity, 71% specificity), while 50 cells/mm³ provided 100% sensitivity, supporting AEC as a rule-out tool. AEC also distinguished active from remission (AUROC 70.5%) and remained predictive in non-atopic patients.

Serum cytokines were assessed in 39 individuals. Active EoE showed elevated eotaxin-3 (AUROC 0.80) and IL-10 (AUROC 0.74); both decreased with treatment and tracked histologic improvement.

Overall, integrating symptom, psychological, behavioral, blood, and serum markers offers a promising non-invasive strategy to diagnose and monitor EoE while reducing reliance on biopsies.