Symptoms gauge pathogenic features of eosinophilic esophagitis in children


Published Online: June 1, 2015

Eosinophilic esophagitis is an inflammation of the esophagus. Symptoms of this chronic (life-long) allergic inflammatory disease include difficulty in swallowing food and abdominal pain. The current focus for evaluating treatment involves looking at changes in the tissues and cells of the esophagus. However, to improve both clinical outcomes and patients’ quality of life, we need to objectively measure and consider both patients’ symptoms and how they feel.

Questionnaires for eosinophilic esophagitis symptoms in children already exist, and some questions may overlap, as they are designed to assess related symptoms. Questions that assess related symptoms are often grouped into categories, for example “dysphagia”, and it is important to confirm that these categories align with clinical and biologic features of disease. In a study recently published in The Journal of Clinical Allergy and Immunology (JACI), L. Martin and her colleagues at Cincinnati Children’s Hospital Medical Center show that symptom categories do correspond with both clinical and biologic features of pediatric eosinophilic esophagitis.  

The authors of this study recruited 46 pediatric patients with eosinophilic esophagitis. A questionnaire called the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS® v2.0) measured symptoms and their impact. On the basis of a previous study, the authors grouped these questions into four categories that represent the major symptom types observed in eosinophilic esophagitis—dysphagia, gastrointestinal reflux disease, nausea/vomiting, and pain. Clinical symptoms were also collected. Tissue and cellular changes in the esophagus were evaluated. To assess molecular changes, the authors used the recently described Eosinophilic Esophagitis Diagnostic Panel. Containing 94 genes abnormally expressed in the esophagus of patients with eosinophilic esophagitis, this panel can aid in diagnosis and monitoring.

The authors demonstrated that the four PEESS® v2.0 categories were meaningful. Each corresponded with clinical symptoms of eosinophilic esophagitis. Importantly, the biologic features most closely aligned with the dysphagia category. However, dysphagia only modestly corresponded with the main biologic measure of disease activity, eosinophil number. Eosinophil activity, mast cells, and gene expression were more closely associated with the dysphagia category. Eosinophil activity is a marker of immune cell activity. Mast cells are immune cells involved in the development of eosinophilic esophagitis. These results suggest that eosinophil activity and mast cells may contribute to dysphagia symptoms.  

Using the Eosinophilic Esophagitis Diagnostic Panel, the authors linked particular genes with the categories, thus revealing key steps involved in the clinical manifestations of this disease.

This work is an essential step toward improving the outcomes of patients with eosinophilic esophagitis. With the PEESS® v2.0 categories, researchers can better track disease activity in clinical settings. The categories will also aid diet intervention and drug trials. Long term, this work may help identify the biologic pathways to target for intervention.


The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI and is the most-cited journal in the field of allergy and clinical immunology.

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