As body mass index (BMI) increases in patients with eosinophilic esophagitis (EoE), histologic, symptomatic, and endoscopic responses to topical corticosteroids decrease, a study found.
To determine whether outcomes of treatment with topical corticosteroids in patients with EoE vary by BMI, researchers used a U.S. university database to conduct a retrospective cohort study of patients ages 14 years or older with a new diagnosis of EoE. They calculated patients' BMI and recorded and compared their histologic, symptom, and endoscopic responses to topical corticosteroids. Results of the study were published Nov. 18 by Clinical Gastroenterology and Hepatology.
Two hundred ninety-six patients with EoE treated with topical corticosteroids were included in the study. Baseline characteristics were similar for patients with and without obesity, although the former group had more heartburn and hiatal hernias. Histologic response was higher for those without versus with obesity at fewer than 15 eosinophils per high-power field (61% vs. 47%; P=0.049) and at 6 or fewer eosinophils per high-power field (54% vs. 38%; P=0.02), respectively.
After adjustment for age, heartburn, dilation, and hiatal hernia, higher BMI was independently associated with decreased histologic response to topical corticosteroids whether BMI was assessed as a continuous variable (adjusted odds ratio [aOR], 0.93; 95% CI, 0.89 to 0.98), as a comparison of patients without versus with obesity (aOR, 0.38; 95% CI, 0.21 to 0.68), or by category (aOR, 0.46; 95% CI, 0.26 to 0.84 for overweight vs. normal weight and aOR, 0.26; 95% CI, 0.13 to 0.51 for obesity vs. normal weight). Lower endoscopic and symptom responses were also seen with increasing BMI.
Each 1-point increase in BMI was associated with a 7% decrease in odds of histologic response, and patients with obesity had about 40% odds of responding compared with patients without, the researchers concluded. They noted that given few known predictors of response to topical steroids in EoE, clinicians may want to consider BMI in their treatment algorithm and when discussing EoE treatments with patients. In particular, patients with a higher BMI might benefit from starting on combination therapy with proton-pump inhibitors and topical steroids or from a regimen such as dietary elimination, they said.