Patient Response to Corticosteroids for EoE May Be Tied to BMI

Overweight and obesity may weaken response to topical corticosteroid treatment among patients with eosinophilic esophagitis (EoE), according to study results published online ahead of print in Clinical Gastroenterology and Hepatology.

“As body mass index (BMI) increases in EoE patients, the odds of histologic, symptomatic, and endoscopic response to topical corticosteroids decreases, with obese patients having approximately 40% odds of response,” wrote researchers from the Department of Medicine of the University of North Carolina at Chapel Hill.

The retrospective cohort study looked at data from the University of North Carolina EoE Clinicopathologic Database for 296 patients 14 years or older with a new diagnosis of EoE. At baseline, characteristics were similar among patients, with the exception of more heartburn and hiatal hernias among patients with obesity.

Histologic, endoscopic, and symptomatic responses to treatment with topical corticosteroids were greater in patients without obesity compared to patients with obesity. Histologic response of fewer than 15 eosinophils per high-power field was achieved by 61% of patients without obesity and 47% of patients with obesity, according to the study. A response of 6 eosinophils per high-power field was achieved by 54% of patients without obesity and 38% of patients with obesity.

After accounting for age, heartburn, dilation, and hiatal hernia, increasing BMI was independently associated with decreased histologic response, researchers reported. Multivariate analyses revealed the following adjusted odds ratios of treatment response: 0.93 when BMI was assessed as a continuous variable; 0.38 when BMI was assessed as without obesity vs with obesity; 0.46 when BMI was assessed as with overweight vs without overweight; and 0.26 when BMI was assessed as with obesity vs without overweight.

Reference:
Ketchem CJ, Ocampo AA, Xue Z, et al. Higher body mass index is associated with decreased treatment response to topical steroids in eosinophilic esophagitis. Clin Gastroenterol Hepatol. Published online August 21, 2023. DOI: 10.1016/j.cgh.2022.11.004