Obese Patients With Eosinophilic Esophagitis Have Lower Response to Therapy

Current treatment options for patients with eosinophilic esophagitis (EoE) include the use of topical corticosteroids. This study aimed to demonstrate whether outcomes of topical corticosteroids vary by body mass index (BMI). 

This retrospective cohort study of 296 patients (68 obese) was conducted at a single tertiary care center. All patients were aged 14 years or older, had been treated with a topical corticosteroid, and had undergone a follow-up endoscopy. The authors evaluated BMI from the date of EoE diagnosis. 

Although clinical symptoms did not significantly vary between obese (BMI ≥30) and nonobese patients, obese patients had more incidences of heartburn (59% vs 37%; P=.001). Posttreatment, the eosinophil count was higher in obese compared with nonobese patients (36.1 ± 47.3 vs 21.5 ± 34.2; P=.003). Nonobese patients had a greater endoscopic response (76%) versus obese patients (59%; P=.006). Higher BMI also was found to be independently associated with a decreased histologic response (adjusted odds ratio [aOR], 0.93 for each unit increase in BMI; 95% confidence interval [CI], 0.89-0.98) versus nonobese (aOR, 0.38; 95% CI, 0.21-0.68). With each 1-point increase in BMI, the odds of histologic response to topical corticosteroids decreased by 7%.