Clinical and anamnestic characteristics and features of the cytokine profile in pediatric patients with fibrostenotic phenotype of eosinophilic esophagitis: a cohort study

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease with a complex pathobiological mechanism. Understanding the differences in the cytokine profile in patients with different phenotypes of the disease can contribute to a more personalized approach to the management of children with EoE. The purpose of this research was to identify clinical and anamnestic features and differences in the cytokine profile in children with inflammatory and fibrostenotic phenotypes of EoE and to evaluate the significance of biomarker levels in predicting the severity of the disease in children. Materials and methods used: a single-center retrospective study was performed that included 40 patients, all under 18 years old, with EoE, who were then divided into two groups as follows: with fibrostenotic (G1; 7) and inflammatory (G2; 33) phenotypes. A comprehensive assessment of clinical and instrumental examination data was performed including endoscopic and morphological changes in the esophageal mucosa. Blood serum samples were taken from all patients in order to determine the levels of T2 inflammation biomarkers using the enzyme immunoassay. Results: in G1 compared with G2, an earlier onset of disease symptoms (5.7 (4.2; 11.5) v. 10.7 (5.3; 14.8) y/o, p=0.012) and a later diagnosis (38 (2.0; 64.0) v. 9 (6.0; 22.0) months, p=0.004) were revealed. The concentration of IL-33 was statistically significantly higher in G1 (p<0.001) while the IL-5 level was statistically significantly higher in G2 (p=0.012). The area under the ROC curve, corresponding to the relationship between the prediction of the presence of the esophageal stenosis and the concentration of IL-33, was 0.951±0.045 with 95% CI: 0.845-0.986 (p<0.001). The IL-33 threshold value was 1315.0 pg/ml: with an increase in the IL-33 concentration a high risk of esophageal stenosis was predicted. The sensitivity of the parameter was 85.7%, the specificity was 82.2%. Conclusion: IL-33 can be a useful diagnostic marker for predicting the fibrostenotic phenotype of EoE. Comprehensive assessment of clinical characteristics and T2 inflammation biomarkers has significant diagnostic value for personalized treatment of children with EoE.