The DiNAM-EoE-C Study: Esophageal Distensibility and Novel Assessment of Motility in Eosinophilic Esophagitis

The DiNAM-EoE-C Study: Esophageal Distensibility and Novel Assessment of Motility in a Eosinophilic Esophagitis Cohort With Residual Symptoms Despite Histological Remission

Eosinophilic esophagitis is a chronic immune-mediated disease that may progress to fibrostenotic remodeling, leading to symptoms such as dysphagia, chest pain, and food impaction. Although current therapies aim to achieve inflammatory control and prevent fibrosis, some patients remain symptomatic despite endoscopic and histologic remission. In this subgroup, symptoms may reflect reduced esophageal distensibility, motility abnormalities, or altered symptom perception related to hypervigilance. This study aims to evaluate symptomatic EoE patients in histologic remission by assessing esophageal distensibility with FLIP before and after endoscopic dilation, investigating motility abnormalities with HRM, and exploring the role of hypervigilance in clinical outcomes.

Inclusion Criteria:

1. Age ≥ 18 years;
2. Confirmed diagnosis of eosinophilic esophagitis in histological remission (<15 eosinophils/HPF);
3. Persistent symptoms (e.g., dysphagia, food impaction, chest pain) despite medical or dietary therapy;
4. Stable EoE therapy throughout the study duration (proton pump inhibitors, budesonide, dupilumab, dietary therapies);
5. Signed informed consent.

Exclusion Criteria:

1. Previous diagnosis of severe erosive esophagitis (Los Angeles grade C or higher);
2. Previous diagnosis of esophagogastric junction outflow disorders (e.g., achalasia);
3. Systemic diseases involving the esophagus (e.g., scleroderma);
4. Use or initiation during the study of immunosuppressive or biological drugs, or medications affecting esophageal motility (opioids, nitrates, calcium channel blockers);
5. Presence of R3 and/or S1 (according to EREFS).