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. 2025 May;70(5):1824-1831.
doi: 10.1007/s10620-025-08874-7. Epub 2025 Mar 1.

An Esophageal Luminal Diameter of 16 mm Predicts Dysphagia Resolution in Eosinophilic Esophagitis

Claire A Beveridge  1   2 , Christina Hermanns  3 , Shivani Thanawala  4 , Qijun Yang  5 , Yi Qin  6 , Prashanthi N Thota  6 , Matthew Hoscheit  6 , J Mark Brown  7   8 , Andrei I Ivanov  9 , Anthony Lembo  6 , Scott Gabbard  6 , Florian Rieder  6   9   10
Affiliations

An Esophageal Luminal Diameter of 16 mm Predicts Dysphagia Resolution in Eosinophilic Esophagitis

Claire A Beveridge et al. Dig Dis Sci. 2025 May.

Abstract

Goals and background: Eosinophilic Esophagitis (EoE) is a chronic inflammatory esophageal disorder, often complicated by strictures requiring dilation. There is limited information on the target esophageal luminal diameter (ELD) post-treatment to relieve symptoms. The aim of this study was to determine the ELD threshold associated with dysphagia resolution in EoE patients in histologic remission.

Study: We performed a retrospective cohort study of adult EoE patients with a stricture in histologic remission. Patients were excluded if symptoms, EoE endoscopic reference score (EREFS), and ELD were missing. ELD was estimated by dilator diameter, endoscope passage, or functional lumen imaging probe. Symptoms, demographics, EREFS, and histology were recorded. Univariate and multivariable logistic regression analyses were performed. The ELD threshold for dysphagia was determined using receiver operating characteristics analyses.

Results: Of the 76 patients who met criteria, 63 (82.9%) reported dysphagia. For every one-millimeter decrease in ELD, there was an increased odds of having dysphagia (OR 9.12, 95% CI 33.4, p < 0.001). The threshold ELD for having dysphagia was less than 16 mm (sensitivity: 96.8%, specificity: 92.3%). In a subcohort analysis of patients who were dilated (n = 58, 76.3%), the main predictor for persistent dysphagia post-dilation was the pre-dilation ELD (aOR 0.77, 95% CI 0.65-0.87, p < 0.001).

Conclusion: A decrease in ELD is associated with a higher odds of dysphagia in EoE patients in histologic remission. ELD of 16 mm or greater provided the strongest threshold for which symptoms were absent. This may present a reasonable dilation target.

Keywords: Dilation; Eosinophilic Esophagitis; Esophageal narrowing; Stenosis; Stricture.

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Conflict of interest statement

Declarations. Conflict of interest: Disclosures for all authors are listed below. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Ethical approval: This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of Cleveland Clinic who determined that our study did not need ethical approval. An IRB exemption was provided for this study.

Figures

Fig. 1
Fig. 1
ROC analysis of esophageal lumen diameter size that predicts dysphagia in patients with eosinophilic esophagitis in histologic remission with a stricture. The area under the curve was 0.97 (95% CI 0.93–1). ELD of < 16 mm was found to have a 96.8% sensitivity and 92.3% specificity with accuracy of 96.1% to predict dysphagia. AUC: area under the curve. mm: millimeter. ROC: receiver operating characteristics
See this image and copyright information in PMC

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