The patient community for Eosinophilic Oesophagitis (EoE) benefits greatly from advancements in diagnostic and evaluating tools.
A Recent publication in Gastroenterology and Endoscopy News highlights the potential of Total Wall Thickness measurement as a promising evaluating tool to assess EoE activity and treatment efficacy.

What is Eosinophilic Oesophagitis (EoE)

Eosinophilic Oesophagitis (EoE) is a chronic immune-mediated condition where eosinophils (a type of white blood cell) build up in the oesophagus, leading to inflammation. This can cause difficulties swallowing, food impaction, and chest pain. EoE is often associated with allergies and can affect people of all ages. The condition requires medical diagnosis and management to alleviate symptoms and prevent long-term complications.

Current Diagnosing Tools For Eosinophilic Oesophagitis

Patients with EoE urgently need more advanced diagnostic tools due to the complex nature of the disease, which often presents with symptoms similar to other gastrointestinal diseases. 

These tools help distinguish EoE from other conditions, accurately assess the extent of oesophageal damage, and tailor treatments to individual needs, thus improving patient outcomes and quality of life.

Traditionally, the evaluation of EoE has relied on histology, eosinophil counts, and symptom assessment, which don't always reflect the extent of oesophagal remodelling. The new approach focuses on the physical changes in the oesophagus, particularly wall thickness, to provide a more direct understanding of disease progression and response to treatment.

Total Wall Thickness: a new potential diagnostic tool for paediatric Eosinophilic Oesophagitis

endoluminal functional lumen imaging probe (EndoFLIP) during a procedure

Using the ultrasound, the investigators compared the mid and distal oesophageal wall thickness in children with an active EoE, EoE in remission and children without it.

A study by Dr Simon Rabinowitz and colleagues at SUNY Downstate University Health Science Center showed that children with active EoE exhibit significantly thicker oesophagal walls than those in remission or without the condition. Additionally, ultrasound showed reduced wall thickness in older patients receiving the appropriate treatment.

They showed that wall thickness decreased once kids went into remission. This provides evidence for structural improvements with treatment in the pediatric population. -   Calies Menard-Katcher, MD, a paediatric gastroenterologist at Children’s Hospital Colorado, in Aurora (not involved in the study).

This correlation points to the potential of ultrasound measurements in tracking and managing EoE effectively, especially in older children undergoing more extensive oesophagal remodelling.

The study also introduces the endoluminal functional lumen imaging probe (Endoflip, Medtronic) device (shown in the picture above) as an alternative method for assessing oesophagal flexibility and remodelling. This technique provides simplicity and efficiency and could complement traditional ultrasound by providing a comprehensive view of the oesophagus's condition.

Further Perspective

Dr Menard-Katcher emphasises that besides being simpler and faster than endoscopic ultrasound, which saves both patient and clinician time, Endoflip can evaluate the whole length of the oesophagus.

However, Dr. Rabinowitz notes that further studies need to determine which tool will be used as the main one and which will be an additional option.
He highlighted the need for a standardised approach to perform the procedure, as well as the need for formal training.

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