Clinical characterization and first-line treatment response in patients with eosinophilic esophagitis: experience from a Portuguese lmmunoallergology department
Caracterização clínica e resposta ao tratamento de primeira linha em doentes com esofagite eosinofílica: experiência de um serviço português de imunoalergologia
Ana Graça Bernardino, Margarida Gomes, Célia Costa
Abstract
Background: Eosinophilic Esophagitis (EoE) is a chronic immune- and allergen-mediated disease with incompletely understood pathogenesis. Treatment aims to relieve symptoms, control inflammation, prevent complications, and improve the quality of life. Despite first-line therapies, the treatment response remains poorly understood. This study aimed to characterize an EoE cohort, evaluate the effectiveness of conventional treatments, and determine possible biomarkers of response. Methods: We conducted a retrospective study of patients with EoE who were followed up from 2009 to 2023. Results: A total of 130 patients with EoE were included: 79.2% were male, and the median (IQR) age was 24 (18) years. The median (IQR) age at symptom onset was 13 (15) years and at diagnosis was 17 (18.5) years. The mean time gap between symptom onset and diagnosis was 49 months. Food impaction and dysphagia were the most frequent symptoms, 72.3% and 66.2%. Of these, 51.5% had severe clinical disease, and 42.3% had histologically severe disease. Of the patients, 84% had atopic comorbidities, 67% had food sensitization, and 80.8% had aeroallergen sensitization. Regarding therapeutic response, 20.8% were complete responder (G1), 9.2% nonresponder (G2), 64.6% partial responders(G3), and 5.4% were awaiting evaluation. In G3,65.5% maintained symptoms, 94% endoscopic, and 88.4% histological abnormalities. Therapeutic G1vsG2, G1vsG3 or G1vsG2+G3 did not show significant differences. In G1vsG2+G3, significant differences were observed in peripheral eosinophils (360vs530/ul, p=0.047) and histologically severe disease (18.5vs51%, p=0.003). Conclusions: Most patients were male, with a mean delay of 4 years from the symptom onset. Only 21% of patients achieved complete remission with first-line therapy. High baseline peripheral eosinophil levels and severe histological disease were associated with partial/no response to first-line treatments, suggesting distinct pathophysiological mechanisms. Further studies are needed to clarify the immunopathogenesis of EoE and to identify predictive biomarkers.
Keywords
Resumo
Introdução: A esofagite eosinofílica (EoE) é uma doença crônica imunoalérgica de patogênese ainda pouco compreendida. O tratamento visa controlar os sintomas e a inflamação, mas a resposta às terapêuticas de primeira linha permanece pouco esclarecida. Este estudo teve como objetivo caracterizar uma coorte de doentes com EoE, avaliar a eficácia das terapêuticas convencionais e determinar eventuais biomarcadores de resposta. Métodos: Estudo retrospetivo de doentes com EoE seguidos entre 2009 e 2023. Resultados: Foram incluídos 130 doentes com EoE, 79,2% do sexo masculino, com idade mediana (IQR) de 24 (18) anos. A idade mediana (IQR) do início dos sintomas foi de 13 (15) anos e do diagnóstico, de 17 (18,5) anos. O intervalo médio entre o início dos sintomas e o diagnóstico foi de 49 meses. O impacto alimentar e a disfagia foram os sintomas mais frequentes, em 72,3% e 66,2% dos doentes, respetivamente. Doença clínica grave foi observada em 51,5% e doença histológica grave em 42,3%. Comorbilidades atópicas estavam presentes em 84% dos doentes, sensibilização alimentar em 67% e sensibilização a aeroalérgenos em 80,8%. Relativamente à resposta terapêutica, 20,8% foram considerados respondedores completos (G1), 9,2% não respondedores (G2), 64,6% respondedores parciais(G3) e 5,4% aguardavam avaliação endoscópica e/ou histológica. No grupo G3, 65,5% mantinham sintomas; 94% apresentavam alterações endoscópicas e 88,4% apresentavam alterações histológicas. As opções terapêuticas entre G1 vs G2, G1 vs G3 ou G1 vs G2 + G3 não apresentaram diferenças estatisticamente significativas. Na comparação G1vsG2+G3, observaram-se diferenças significativas nos eosinófilos periféricos (360 vs 530/μL, p=0,047) e na presença de doença histológica grave (18,5% vs 51%, p=0,003). Conclusões: A maioria dos doentes era do sexo masculino, com um atraso médio de quatro anos desde o início dos sintomas. Apenas 21% alcançaram remissão completa com terapêuticas de primeira linha. Níveis basais elevados de eosinófilos periféricos e doença histológica grave associaram-se a resposta parcial ou ausente às terapêuticas de primeira linha, sendo necessários mais estudos para esclarecer a imunopatogênese da EoE e identificar biomarcadores preditivos.
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Referências
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Submetido em:
06/01/2026
Aceito em:
25/02/2026
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