Weight Gain May Impair Response to Dietary Therapy in Adults with Eosinophilic Esophagitis

Adults who gained weight while adhering to dietary therapy for eosinophilic esophagitis (EoE) experienced less symptomatic and histologic improvement than those whose weight did not change, according to an analysis featured during Digestive Disease Week 2024. Stephanie Borinsky, MD, a gastroenterology fellow at the University of North Carolina School of Medicine in Chapel Hill, presented the results of a retrospective cohort study designed to evaluate the effects of baseline body mass index (BMI) and weight fluctuations on response to dietary therapy in patients with EoE.

The dietary modification approach is considered an effective first-line therapy for EoE, with variations such as elemental, allergy-test directed, empiric, and targeted elimination diets. While elimination diets may be associated with side effects, including unintentional weigh changes, there is little information on the influence of BMI on treatment response. Borinsky and colleagues sought to determine whether outcomes of dietary therapy in adults with EoE vary based on BMI or change in weight during treatment. A search of electronic health records at their institution helped to identify 169 adults with EoE who were treated with dietary interventions, including empiric elimination (81%), targeted elimination (18%), and elemental (1%) diets. More than half of those patients (57%) had obesity, however, their baseline characteristics did not differ significantly from those of patients considered to be in a healthy weight range (BMI: 18.5-24.9).

BMI values, calculated at the diagnosis and when patients underwent post-treatment endoscopy, showed that nearly 40% of patients in both healthy and obesity BMI ranges gained weight during dietary therapy, regardless of diet type. The patients who gained weight while adhering to the different diets had lower rates of histologic and endoscopic response than those whose weight did not change. Histologic response was assessed using three different thresholds for eosinophil counts (<15 eos/hpf, ≤6 eos/hpf, and <1 eos/hpf). Adults who experienced weight gain also had less improvement in symptoms compared to those who did not (56% vs 72%).

The analyses did not detect a significant interaction between BMI and weight gain, suggesting that the influence of weight gain on outcomes did not differ across BMI classes.

“In adults with EoE, weight gain during diet therapy is associated with decreased treatment response, regardless of baseline weight status,” the author said. “Whether this is a sign of treatment non-adherence or related to underlying EoE pathophysiology remains to be determined.