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Introduction

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease characterized by esophageal dysfunction and a peak eosinophil count of >15 cells per high power field (HPF). Recent studies suggest that mast cells play a key role in its pathophysiology. This study investigates the presence of mast cells in different groups of patients with EoE.

Aims & Methods

Biopsy samples from patients newly diagnosed with EoE were analyzed, and the Eosinophilic Esophagitis Histology Scoring System (EOEHSS) grade and stage scores were calculated. Biopsy samples were divided in two groups: t0 (before the starting of EoE therapy) and t1 (after EoE therapy). Mast cells were detected using tryptase immunohistochemistry, and the maximum number of mast cells counted in a high-power field (PMC), was recorded. Univariate correlation analysis were performed between PMC and peak eosinophil count (PEC), PMC and EOEHSS grade, PMC and EOEHSS stage, PMC and EREFS.

Results

12 patients affected by EoE were divided in group 1, treated with PPIs [Esomeprazole 40 mg, bis in die (bid)] and group 2, treated with BOT (budesonide oral tablets 1 mg, bid). Univariate correlation analysis were performed at t0 and t1. Results from Pearson’s R for analysis at t0 are showed a positive linear correlation in PEC-PMC (0,567, p=0,043) and EOEHSS grade-PMC (0,559, p=0,047). At t1, EREFS-PMC had a positive correlation (0,726, p 0,005), like also EOEHSS grade-PMC (0,74, p=0,002) and EOEHSS stage-PMC (0,818, p<0,001).

	R	p
EREFS-PMC (t0)	0.244	0.423
PEC-PMC (t0)	0.567	0.043
EOEHSS grade-PMC (t0)	0.559	0.047
EOEHSS stage-PMC (t0)	0.390	0.187
EREFS-PMC (t1)	0.726	0.005
PEC-PMC (t1)	0.340	0.256
EOEHSS grade-PMC (t1)	0.74	0.002
EOEHSS stage-PMC (t1)	0.818	<0.001

Conclusion

PCM positively correlates with PEC, EOEHSS grade, EOEHSS stage and EREFS in untreated samples, supporting their role in EoE and type-2 inflammation. In treated cases, PMC correlate with PEC, EOEHSS grade, EREFS. A highly statistically significant strong positive linear correlation was found between PMC and EOEHSS stage, as the latter is more likely to reflect the whole esophageal histologic changes.
Our study suggests that mast cell count, alongside eosinophil counts, could be an important factor in evaluating anti-inflammatory therapeutic interventions and it may be a useful adjunct to existing endoscopic and histologic markers in assessing EoE severity, supporting their role in EoE and type-2 inflammation. To confirm these findings, further longitudinal prospective studies are required.

References

N. de Bortoli, P. Visaggi, R. Penagini et al., The 1st EoETALY consensus on the diagnosis and management of eosinophilic esophagitis – Definition, clinical presentation and diagnosis, Digestive and Liver Disease
Collins MH, et al. Eosinophilic esophagitis histology remission score: significant relations to measures of disease activity and symptoms. J. Pediatr. Gastroenterol. Nutr. 2020;70(5):598–603
Kanamori A, et al. Esophageal mast cells may be associated with the perception of symptoms in patients with eosinophilic esophagitis. Esophagus. 2023 Apr;20(2):333-341
Bolton SM, et al. Mast Cell Infiltration Is Associated With Persistent Symptoms and Endoscopic Abnormalities Despite Resolution of Eosinophilia in Pediatric Eosinophilic Esophagitis. Am J Gastroenterol. 2020 Feb;115(2):224-233.

THE ROLE OF MAST CELLS IN EOSINOPHILIC ESOPHAGITIS: A PRELIMINARY STUDY

Domenico Novielli 1, Andrea Quaranta 2, Andrea Marzullo 2, Mariabeatrice Rita Daniela Principi 2

1 National Institute of Gastroenterology "S. de Bellis", Castellana Grotte, Italy|||University of Bari, Italy, Bari, Italy

2 University of Bari, Italy, Bari, Italy

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Podcast Episode

UEG Podcast

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The future of immunotherapy → are surgeons obsolete soon? with Jeroen Dekervel

Jeroen Dekervel, Pradeep Mundre

Topics

Digestive Oncology

Published

2026

UEG Podcast Episode

Journal Podcast

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UEG Journal Best Paper Award

Mohsan Subhani, Maria Manuela Estevinho, Malte Buchholz

Published

2025

UEG Presentation

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GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

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Introduction

Genetic variants associated to a higher risk of developing eosinophilic esophagitis (EoE) and other atopic conditions have been described. However, no study has investigated how these genetic variants influence clinical features of EoE or the atopic concomitances that usually accompanied this disease.

Aims & Methods

This study aims to assess whether single nucleotide polymorphisms (SNPs) in genes related to EoE and atopies associate with disease features and atopic concomitances in a large, representative cohort. Patients diagnosed of EoE according to clinical guidelines were recruited from 4 Spanish referral hospitals and demographical and clinical data were obtained both retrospectively and prospectively. The concomitant atopies analyzed were rhinitis, conjunctivitis, asthma, dermatitis and any food allergy. The recruited cohort was randomly divided into discovery (DC) and validation cohorts (VC) (70% and 30%, respectively). Genotyping was performed using an Open Array platform with 60 SNPs on DNA obtained from peripheral blood. Chi-square or Fisher’s exact test were used for statistical comparisons.

Results

Overall, 647 patients (74.7% male, 32.4±15.2 mean age) were included; 81% of them with an inflammatory phenotype. Rhinitis was the most common atopy (55.8%), while dermatitis was the least frequent (17.5%). Food allergy was documented in 28% of patients.
In relation to EoE characteristics, four SNPs were initially associated with endoscopic findings (measured by EREFS score) and with peak eosinophil counts in esophageal biopsies within the discovery cohort. However, only rs77569859 in the CAPN14 gene remained statistically significant in the validation cohort. TC and CC genotypes of this variant, present in 23.7% of the cohort, were associated with lower EREFS score under a dominant model (3.30±1.60 vs 2.92±1.66, p=0.011 DC/0.002 VC). Additionally, rs76562819, also in CAPN14 gene, showed a trend toward a lower peak eosinophil count per high power field (47.7±24.4 vs 66.6±48.3, p=0.005 DC/0.116VC) under a recessive model (AG and GG genotypes in 11.3% of our patients).
Regarding atopic comorbidities, rs1800925-TT in IL13 (found in 5.7% of our patients) was associated a higher prevalence of conjunctivitis (60% vs 39% in the overall cohort, p=0.020 DC/0.057 VC) and showed a trend toward increased asthma prevalence (54% vs 35%, p=0.056 DC/0.155 VC). A weaker association with asthma was observed for STAT6 rs324015, with an increased prevalence in patients with AG and GG genotypes (41% vs 32%, p=0.079 DC/0.162 VC; present in 34.9 % of the cohort). For dermatitis, a protective effect was seen in patients with the TT genotype of rs2032582 in ABCB1 gene (found in 16.1% of our patients), as the prevalence decreased from 19% to 8% (p=0.033 DC/0.157 VC). No consistent associations were found for rhinitis or food allergy with any SNP across both cohorts.

Conclusion

We have identified significant associations between genetic variants and both clinical features and atopic comorbidities in Spanish patients with EoE, highlighting the potential of genetic profiling to improve clinical characterization and patient management.

GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Leticia Rodríguez-Alcolado 1, Marcos Navares-Gómez 2, Sergio Casabona-Francés 3, Javier Molina-Infante 4, Danila Guagnozzi 5, Paula Soria-Chacartegui 2, Sara Feo Ortega 6, Laura Arias-González 7, Macarena Torres-Larrubia 8, Ronald Llerena Castro 5, Verónica Martín Domínguez 3, Jose Zamorano 8, Francisca Molina-Jiménez 3, Pedro L Majano 9, Jennifer Fernández-Pacheco 3, Dolores Rivas 8, Elena Grueso-Navarro 7, Pablo Zubiaur 2, Francisco Abad-Santos 10, Cecilio Santander Vaquero 11, Alfredo J. Lucendo 12, Emilio Jose Laserna-Mendieta 7

1 Hospital General de Tomelloso, Gastroenterology Research Unit / Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Tomelloso, Spain|||Universidad de Alcalá, Alcalá de Henares (Madrid), Spain

2 Hospital Universitario de La Princesa, Clinical Pharmacology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain

3 Hospital Universitario de La Princesa, Gastroenterology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain

4 Hospital San Pedro de Alcantara, Caceres, Spain|||Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

5 Hospital Universitario Vall d'Hebron, Barcelona, Spain

6 Hospital General de Tomelloso, Pediatrics / Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Tomelloso, Spain

7 Hospital General de Tomelloso, Gastroenterology Research Unit / Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Tomelloso, Spain|||Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

8 Hospital San Pedro de Alcantara, Caceres, Spain

9 Hospital Universitario de La Princesa, Gastroenterology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain|||Universidad Complutense de Madrid, Madrid, Spain

10 Hospital Universitario de La Princesa, Clinical Pharmacology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain|||Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

11 Hospital Universitario de La Princesa, Gastroenterology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain|||Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

12 Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain|||Hospital General de Tomelloso, Gastroenterology / Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Tomelloso, Spain

Event

UEG Week Berlin 2025

Topics

Histopathology Mechanisms & Personalised Medicine Oesophagus

Submission format

Abstract

Session

EoE: From gene to clinic

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Therapy update EoE: Conventional treatment and treatment options for children

Jorge Amil Dias 1, Ulrike von Arnim 2

1 Hospital Lusíadas, Porto - Paed. Gastroenterology, Porto, Portugal

2 Otto-Von Guericke University, Madgeburg, Germany

Event

UEG Week Berlin 2025

Session

Therapy update: EoE

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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EVALUATION OF RECTAL WALL THICKNESS MEASUREMENT SENSITIVITY VIA TRANSABDOMINAL ULTRASOUND TO ASSESS MUCOSAL ACTIVITY IN ULCERATIVE COLITIS: COULD THIS BE A USEFUL NON-INVASIVE TOOL?

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Introduction

Ulcerative colitis (UC) is a chronic inflammatory bowel disease where accurate assessment of disease activity is essential for effective patient management. Endoscopy is the gold standard for evaluating mucosal inflammation, but non-invasive alternatives, such as transabdominal ultrasound (TAUS), are garnering interest.

Aims & Methods

This study aimed to evaluate the sensitivity of rectal wall thickness measurements using TAUS in assessing disease activity in ulcerative colitis, and to identify an ideal cut-off threshold by comparing results with endoscopic and histological findings.
In a prospective, observational study, we enrolled consecutive patients with UC who were referred to our tertiary center from May 2024 to April 2025. Eligibility required a scheduled TAUS within 30 days of a staging colonoscopy, without intervening therapy adjustments. Exclusion criteria included technically inadequate TAUS readings (e.g., due to anatomical variations or excessive gas interposition) and minor-aged patients. Each patient underwent TAUS performed by a single, experienced operator. A second experienced operator blind assessments were recorded to evaluate inter-observer variability. Rectal wall thickness was measured and compared with clinical, laboratory (CRP, fecal calprotectin), and endoscopic (MAYO score) indicators of disease activity. Histological status (active/inactive) and additional clinical data, including disease duration, extent, and therapy, were recorded.

Results

A total of 74 patients were analyzed, of whom 51.4% were female, with a median age of 55 years (IQR: 42–68). The majority presented with left-sided colitis (Montreal E2, 62.2%), followed by extensive colitis (E3, 25.7%) and proctitis (E1, 12.1%). The median disease duration was 12 years (IQR 5–23). Patients with an endoscopic MAYO score of 0 or 1 had a median rectal wall thickness of 4.95 mm (IQR 4.5–5.88), while those with a score of 2 or 3 had a median of 6.15 mm (IQR 5.3–6.7; p=0.003). Receiver Operating Characteristic (ROC) analysis for TAUS rectal wall thickness showed good discriminatory ability for endoscopic activity (cut-off: 5.55 mm, AUC 0.725, 95CI 0.597-0.853, Se 0.80, Sp 0.71), comparable to fecal calprotectin (cut-off: 277 µg/g, AUC 0.717, 95CI 0.589-0.845, Se 0.70, Sp 0.66; p=0.256) and superior to CRP (cut-off: 1 mg/L, AUC 0.511, 95CI 0.357-0.664, Se 0.50, Sp 0.50; p<0.0001). For histological activity, TAUS again performed well (cut-off: 5.55 mm, AUC 0.794, 95CI 0.682-0.906, Se 0.76, Sp 0.80), closely matching fecal calprotectin (cut-off 302, AUC 0.744, 95CI 0.627-0.861, Se 0.69, Sp 0.73; p=0.425) and outperforming CRP (cut-off 1.5, AUC: 0.631, 95CI 0.497-0.765, Se 0.62, Sp 0.63; p<0.0001). Inter-observer agreement for TAUS rectal wall thickness was excellent, with an intraclass correlation coefficient of 0.923 (p<0.0001), underscoring the reproducibility of this non-invasive method.

Conclusion

TAUS measurement of rectal wall thickness demonstrates promising sensitivity and reproducibility in detecting mucosal and histological activity in UC, aligning closely with established markers such as fecal calprotectin. A cut-off value of 5.55 mm showed good discriminatory performance in this cohort, suggesting potential utility as a non-invasive marker of disease activity..Given its non-invasive nature, low cost, and strong inter-observer agreement, TAUS is a valuable adjunct for routine UC monitoring. Combined with clinical and biochemical data, it may reduce the need for repeated endoscopy, minimizing patient burden, healthcare costs, and environmental impact.