The Effect Of Eosinophilic Esophagitis On Exercise Parameters In Children

BACHGROUND: Eosinophilic Esophagitis (EOE) is a chronic esophageal disorder associated with aberrant esophageal function stemming from food allergies and diverse allergens. Clinical manifestations include heartburn, abdominal pain, vomiting, dysphagia, food impaction, and potential chronic esophageal stenosis. EOE is associated with multisystem involvement such as asthma, allergies, atopic dermatitis, and diminished quality of life. While there is growing data on the association between various chronic diseases with multisystem involvement and exercise performance, such studies in EOE are scarce. PURPOSE: To evaluate the effect of EOE on exercise parameters in children and to assess cardiac, pulmonary, and muscular function during exercise compared to a healthy controls. METHODS: A prospective, controlled study assessing Cardiopulmonary Exercise Testing (CPET) using treadmill in EOE patients aged 6-18 years diagnosed with EOE vs. a healthy control group (age, sex, and BMI percentile matched). Primary outcome was peak oxygen uptake (peak VO2). Secondary objectives were respiratory and cardiac parameters. RESULTS: The study enrolled a total of 54 participants, 18 in the EOE group and 36 in the control group. Peak VO2 demonstrated no significant difference between the groups (EOE 39.4 ± 10.2 ml/kg/min, 82.5 ± 20.6 %pred vs. Control 41.1 ± 10.34 ml/kg/min, 91.5 ± 20.7 %pred, p = 0.23). However, the relative Anaerobic Threshold (AT) was significantly lower in the EOE group (EOE 42.2 ± 9.4% vs. Control 48.1 ± 10.3%, p = 0.044). Respiratory limitation (breathing reserve), cardiac limitation (oxygen pulse and heart rate response), breathing efficiency (respiratory equivalents, VE/VCO2) parameters or oxygen desaturation did not differ between the groups. No evidence of exercise induced bronchoconstriction was found in the EOE group. CONCLUSIONS: Similar exercise capacity was found for EOE patients and healthy control children. Lower AT (although within the normal values) in the EoE patient group, could signify a potential alteration in peripheral muscle tissue metabolism. Larger, more comprehensive studies are needed, focusing on muscle physiology to identify potential underlying mechanisms in this unique population.