The American Gastroenterological Association (AGA) Journal published a cross-sectional study. The study’s main objective was to identify and assess phenotypes of Eosinophilic Esophagitis (EoE) by employing a functional lumen imaging probe (FLIP) panometry, thus creating a PhysioMechanical classification system for EoE. 

What is EoE?

EoE is a chronic disease affecting the oesophagus, the tube connecting the mouth and stomach. Too many eosinophils, a type of white blood cell, in the oesophagus, causes inflammation, making swallowing difficult.

It also presents varied manifestations, including fibrostenotic remodelling of the oesophagus and abnormal oesophagal motility. 

The Study Objectives

The main objective of this study was to establish and analyse distinct EoE phenotypes by applying functional lumen imaging probe (FLIP) panometry, a PhysioMechanical classification of EoE. 

This could provide an improved understanding of the different phenotypes, disease presentations, and treatment responses, aiding in more accurate diagnosis and targeted treatment. 

Methods

In this research, the investigators selected 215 patients diagnosed with EoE who had undergone a Functional Lumen Imaging Probe (FLIP) procedure during endoscopy. They analysed FLIP studies for distensibility plateau and compliance of the oesophagal body, maximum esophagogastric junction diameter, and contractile response pattern. Then they employed these features derived from the FLIP analysis to construct PhysioMechanical classifications, providing a new perspective on EoE evaluation.

Results

The study included 215 EoE patients, averaging 38 years old, with 31% female. The data identified seven distinct PhysioMechanical classifications, differentiated by certain clinical traits such as symptom duration and Endoscopic EoE Reference Scores (EREFS).

In particular, patients categorised under “nonreactive fibrostenosis” (14 in number) showed prolonged symptom duration (median of 20 years, ranging between 10 and 30 years) and more frequently had EREFS grade 2 or 3 ring scores compared to those categorised as “normal.”

Additionally, for patients who were not on treatment at the time of the cross-sectional evaluation (46 in number), there was a significant difference in their future response rates to proton pump inhibitors (PPI) based on their PhysioMechanical classifications. This response rate pertained to achieving a peak mucosal eosinophil count of less than 15 per high-powered field post-PPI treatment. The PPI response varied from as high as 87% in patients classified with “isolated esophagogastric junction outflow obstruction” to as low as 11% in those classified with “spastic-reactive fibrostenosis.”

Conclusions

Graphical abstract, The American Gastroenterological Association (AGA) Journal

This research shows that using a FLIP panometry tool to classify EoE can help doctors understand how severe the disease is in different patients. 

This is important for two reasons. 

First, doctors can provide a treatment plan best suited for each patient by knowing how severe the disease is. 

Second, this new way of classifying the disease can help doctors predict how well patients might respond to their treatment. This includes medications such as proton pump inhibitors (PPIs), which the study showed worked differently for patients in different groups.

In simpler terms, this method could lead to better, more personalised treatment for patients with EoE. 

But, we need more research to ensure these findings are accurate and fully understand how to use this information in real-life medical practice.

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