TOPLINE:

Blood eosinophil count at a threshold of 155 eosinophils per mm³ demonstrated high sensitivity and specificity for diagnosing eosinophilic oesophagitis (EoE) in patients presenting with dysphagia, whereas a threshold of 325 eosinophils per mm³ showed a high predictive ability for histologic remission.

METHODOLOGY:

• Researchers conducted a prospective study across four Italian centres between January 2024 and September 2025 to evaluate whether levels of peripheral blood eosinophils and lymphocytes could accurately diagnose EoE in adult patients with dysphagia and track tissue healing in those diagnosed with EoE.
• EoE was diagnosed via oesophageal biopsy considering a peak eosinophil count of 15 or more eosinophils per high-power field, with patients off all medications known to alter oesophageal eosinophil levels.
• Participants were categorised as having non-EoE dysphagia if their histology showed a peak eosinophil count of less than 15 eosinophils per high-power field across six oesophageal biopsies.
• A total of 123 patients with EoE (median age, 39.5 years; 68.3% men) and 86 patients with non-EoE dysphagia (mean age, 57.5 years; 52.0% men) were included.
• The correlation of peripheral eosinophil levels with clinical, endoscopic, and microscopic disease severity was assessed.

TAKEAWAY:

• In patients with non-EoE dysphagia, an absolute eosinophil count threshold of 155 eosinophils per mm³ had an area under the receiver operating characteristic curve (AUC) of 85.0%, with a sensitivity of 87.0% and a specificity of 71.0% for detecting histologically active EoE.
• An absolute eosinophil count threshold of 325 eosinophils per mm³ had an AUC of 70.5%, with a sensitivity of 52.7% and a specificity of 82.3% for detecting histologic remission.
• The absolute lymphocyte count did not differ between patients with active EoE and those with histologic remission.
• The absolute eosinophil count showed a positive correlation with the peak eosinophil count on histology and the EoE endoscopic reference score used to determine the severity of endoscopic disease (Spearman's correlation coefficient, 0.4; P < .0001 for both).

IN PRACTICE:

"This is the first multi-centre prospective study suggesting the utility of the full blood count, a common and easily available minimally invasive test, for the diagnosis of EoE but further longitudinal research is needed to validate such findings in the EoE monitoring setting," the authors of the study concluded.

SOURCE:

This study was led by Pierfrancesco Visaggi, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. It was published online on January 07, 2026, in Alimentary Pharmacology & Therapeutics.

LIMITATIONS:

The study's generalisability was limited by its cross-sectional design, the exclusion of patients on dupilumab treatment, and its reliance on tertiary referral centres.

DISCLOSURES:

The authors did not report receiving any specific funding for this study. Several authors reported receiving lecture or consulting fees and serving as a speaker or consultant for various companies including AbbVie, Amgen, and Malesci.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.