Document resource
Introduction Symptoms correlate only modestly with endoscopic and histological activity in Eosinophilic Oesophagitis (EoE). Real-world data show that symptoms detect histological remission with only ~60% accuracy (AUC 0.60–0.61) (Safroneeva et al., 2016). Persistent histological activity is potentially associated with progression to fibrostenotic disease, highlighting the importance of detecting subclinical inflammation. UK, European, and US guidelines therefore recommend reassessment after induction or treatment change (Dhar et al., 2022; Dellon et al., 2018; Papadopoulou et al.,). Whether routine gastroscopy is required in all asymptomatic patients remains uncertain. We assessed whether clinical remission predicts histological remission in treated EoE.Methods We conducted a prospective single-centre cohort study from September 2023 to November 2025. Adults with confirmed EoE underwent reassessment after ≥8 weeks of stable therapy (food elimination diet, proton pump inhibitor, budesonide orodispersible tablets (BOTs), or combinations). All patients completed the Dysphagia Symptom Questionnaire (DSQ) and underwent same-day capsule sponge cytology (Endosign) and gastroscopy with biopsies, as part of another study. Clinical remission was defined as DSQ=0. Histological remission was defined as peak count <15 eosinophils/high-power field (eos phpf) on capsule sponge or histology.Results A total of 136 patients underwent paired symptom and tissue assessment. Median age was 49 years (IQR 37–58.3) and 64% were male. Clinical remission (DSQ=0) was present in 48/136 (35.3%). Overall, 97/136 (71.3%) were in histological remission. Median total EREFS was higher in histologically active disease than remission (4 [IQR 3–4] vs 2 [IQR 1–3], p=2.15×10 −6). Clinical remission did not correlate with histological remission (Fisher’s exact p=0.55; κ=0.05). Using DSQ≥1 to detect histological activity gave sensitivity 69.2%, specificity 37.1%, PPV 30.7% and NPV 75.0%. No differences in clinical correlation were found in those using BOTs compared with other treatments.Conclusions 75% of asymptomatic EoE patients had histological remission. These findings support a targeted rather than universal reassessment strategy, potentially reserving gastroscopy for patients with higher-risk features (e.g., higher index EREFS). Capsule sponge cytology may offer a less invasive monitoring approach. Additional biomarkers beyond eosinophil counts and more sensitive clinical scoring systems are needed.Abstract P7 Table 1Clinical and histological outcomes (N=136)Clinical scoreHistology RemissionHistology ActivePeak eos phpf median (IQR)Treatment duration (weeks)DSQ = 0(n=48) Remission36/48 (75.0%)12/48 (25.0%)0 (0–8)16.1 (12.4–20.0)DSQ ≥1(n= 88) Active61/88 (69.3%)27/88 (30.7%)0 (0–6)15.2 (10.1–21.7)