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ABSOLUTE EOSINOPHIL COUNT IS AN ACCURATE NON-INVASIVE BIOMARKER OF EOSINOPHILIC ESOPHAGITIS: A MULTICENTER PROSPECTIVE STUDY CONFIRMS UTILITY IN CLINICAL PRACTICE

Pierfrancesco Visaggi 1, Gaia Pellegatta 2, Stefano Siboni 3, Irene Solinas 1, Gaia Cairoli 1, Federico Testi 1, Isabella Dulmin 1, Valeria Poletti 2, Giacomo Marcozzi 2, Marco Sozzi 4, Massimo Bellini 1, Emanuele Marciano 5, Alessandro Repici 6, Edoardo Vincenzo Savarino 7, Nicola de Bortoli 1

Affiliations

1 University of Pisa, Pisa, Italy

2 Humanitas Research Hospital, Rozzano, Italy

3 Policlinico San Donato, San Donato Milanese, Italy

4 Policlinico San Donato, Milano, Italy

5 Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

6 Ist. Clinico Humanitas Rozzano, Milano, Italy

7 University of Padua, Padua, Italy

Summary

AI Generated

A prospective multicenter study of 210 patients found that peripheral blood absolute eosinophil count can aid in diagnosing eosinophilic esophagitis among patients with dysphagia and monitoring histological disease activity.

A cut-off of 155 eosinophils/mm3 had 85% AUC, 71% specificity, and 87% sensitivity for identifying EoE among 210 patients with dysphagia (123 with EoE, 87 with non-EoE dysphagia).
For disease monitoring, a cut-off of 325 eosinophils/mm3 distinguished active EoE from histological remission with 70.5% AUC, 52.7% specificity, and 82.3% sensitivity.
Absolute eosinophil count showed modest positive correlation with endoscopic disease activity measured by EREFS score (Spearman's Rho 0.4, p<0.0001) but no correlation with symptom scores.
This study may be relevant for clinicians managing patients with dysphagia or known eosinophilic esophagitis who seek non-invasive biomarkers to support diagnosis and monitor disease activity.

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Abstract

Introduction

Non-invasive biomarkers are needed to improve the management of eosinophilic esophagitis (EoE). We investigated whether eosinophil and lymphocyte counts could be used to diagnose EoE among patients with dysphagia and assess histological, endoscopic, and clinical disease activity in patients with known EoE.

Aims & Methods

This was a prospective study conducted at four EoE referral centers (Pisa, Padova, Humanitas Research Hospital, Milano Policlinico San Donato). We enrolled consecutive patients undergoing esophagogastroduodenoscopy (EGD) for suspected or known EoE who had performed blood counts within one month before EGD. Histological remission and non-EoE-related dysphagia (NED) were defined according to current guidelines on EoE. Endoscopic characteristics were classified according to the EoE reference score (EREFS). Demographic, clinical and full blood count data were collected. After the EGD, all patients completed the Dysphagia Symptom Questionnaire over 14 days (DSQ). Kruskal-Wallis Rank Sum Test and Pearson’s Chi-squared were used for comparisons. ROC curve analysis was used to assess the diagnostic accuracy. Spearman’s test was used for correlations. Significance threshold was p<0.05.

Results

We included 210 consecutive patients. Of these, 123 had EoE (58.5% active; 41.5% in histological remission) while 87 had non-EoE dysphagia (NED). Characteristics in Table 1. Absolute eosinophil count (AEC) of active EoE was significantly higher than NED (335 vs 90/mm3; p<0.001), and so was eosinophil percentage (4.6% vs 1.1%; p<0.001), and median lymphocyte percentage (30 vs 27%; p<0.001). ROC curve analysis showed that a cut-off of 155 eosinophils/mm3 had an AUC of 0.85, with 71% specificity and 87% sensitivity for the identification of EoE among patients with dysphagia (Figure 1a). Other ROC analyses on the diagnosis of EoE reported in Table 2. With regards to disease monitoring, only eosinophil counts differed significantly between EoE and NED. Median AEC of active EoE was higher than EoE in remission (335 vs 200/mm3; p<0.01), and so was eosinophil percentage (4.6 vs 1.4%; p<0.001) (Table 3). Based on ROC analysis, a cut-off of 325 eosinophils/mm3 had and AUC of 0.70 for the identification of histological remission in EoE, with a specificity of 52.7%% and sensitivity of 82.3% (Figure 1b) (Table 3). There was modest positive correlation between AEC and the EREFS with Spearman’s Rho of 0.4 (p<0.0001), but there was no correlation between AEC and DSQ scores (Rho= -0.01; p=0.9).

Conclusion

Our results show that the AEC in peripheral blood has good accuracy for the diagnosis of EoE in patients with dysphagia and moderate accuracy for monitoring histological disease activity. In addition, AEC was modestly correlated with endoscopic disease activity (EREFS score) but not with symptoms.

Characteristic	NED, N = 87 (41%)¹	EoE, N = 123 (59%)¹	p-value²
Absolute eosinophil count	90 (30, 180)	300 (160, 400)	<0.001
Absolute lypmhocyte count	1,970 (1,550, 2,500)	2,000 (1,695, 2,410)	0.47
Characteristic	NED, N = 87 (55%)	Active EoE, N = 72 (45%)	p-value	Cut-off	AUC	Specificity	Sensitivity
Absolute Eosinophil Count	90 (30, 180)	335 (208, 462)	<0.001	155/mm3	85%	71%	87%
Characteristic	Active EoE, N = 72 (59%)	Remission EoE, N = 51 (41%)	p-value	Cut-off	AUC	Specificity	Sensitivity
Absolute Eosinophil Count	335 (208, 462)	200 (105, 300)	<0.001	325/mm3	70.5%	52.7%	82.3%
Lymphocytes percentage	27 (22, 30)	30 (27, 37)	<0.001	29.3%	57%	72.4%	52.2%

Disclosure

Speaker or Consultancy for Apogee Therapeutics, Dr Falk Pharma, Malesci, JB Pharmaceuticals, Sanofi, Alfasigma

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

Mechanism and diagnostics for EoE (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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