Esophageal Remodeling Correlates With Eating Behaviors in Pediatric Eosinophilic Esophagitis

Abstract

Background: There is limited data characterizing eating habits among pediatric patients with EoE. We compared eating behaviors in pediatric EoE patients with healthy controls, and assessed the degree of correlation with symptomatology, endoscopic and histologic findings, and esophageal distensibility. Methods: We conducted a prospective, observational study where subjects consumed four food textures (puree, soft solid, chewable, and hard solid), and were scored for eating behaviors including number of chews per bite, sips of fluid per food, and consumption time. Symptomatic, endoscopic, histologic, and esophageal distensibility data was collected for case subjects. Results: Twenty-seven case subjects and 25 healthy controls were enrolled in our study (mean age 11.0 years, 63.5% male). Compared with healthy controls, pediatric EoE patients demonstrated more chews per bite with soft solid (13.6 vs 9.1, p=0.031), chewable (14.7 vs 10.7, p=0.047), and hard solid foods (19.0 vs 12.8, p=0.037). EoE patients also demonstrated increased consumption time with soft solid (94.7 vs 58.3 seconds, p=0.002), chewable (90.0 vs 65.1 seconds, p=0.005), and hard solid foods (114.1 vs 76.4 seconds, p=0.034) when compared to healthy controls. Subgroup analysis based on disease status showed no statistically significant differences in eating behaviors between active and inactive EoE. Total EREFS score positively correlated with consumption time (r 0.53, p = 0.008) and number of chews (r 0.45, p = 0.027) for chewable foods and with number of chews (r 0.44, p = 0.043) for hard solid foods. Increased consumption time correlated with increased eosinophil count (r 0.42, p=0.050) and decreased esophageal distensibility (r -0.82, p<0.0001). Discussion: Altered eating behaviors including increased chewing and increased consumption time can be seen in pediatric patients with EoE, can persist despite histologic remission, and may be driven by changes in esophageal distensibility.