Intestinal ultrasound findings and their prognostic value in patients with eosinophilic gastroenteritis

Objective Eosinophilic gastroenteritis (EoGE) is a chronic recurrent disorder with elevated eosinophilic infiltration in the gastrointestinal tract. Objective predictors for disease outcomes are lacking. This study aimed to explore the predictive value of baseline intestinal ultrasound (IUS) along with clinical and laboratory characteristics for disease outcomes. Materials and methods This retrospective cohort study enrolled consecutive patients diagnosed with EoGE at a tertiary medical center between 2019 and 2024. Baseline clinical, laboratory, endoscopy data were collected. IUS images were blindly reviewed for features such as disease location, bowel wall thickness, the "piano key sign" (thickened jejunal folds), and ascites. The primary outcome was steroid-free clinical remission at 12 months. Logistic regression analysis was conducted to reveal the predictive factors. Results This cohort comprised 40 patients with a median age of 34.0 years (IQR, 26.8–52.0 years) and 23 (57.5%) were males. The predominant clinical symptoms included abdominal pain (92.5%), vomiting (52.5%) and diarrhea (47.5%). On IUS, 26 (65.0%) patients showed thickened bowel wall between 4 and 7 mm and predominantly localized in the jejunum (42.5%) and ileum (45.0%). The piano key sign was observed in 12 (30.0%) patients, and ascites was present in 17 (42.5%). Steroid-free clinical remission at 12 months was achieved by 15 (37.5%) patients. On multivariable analysis, the piano key sign (OR 0.092, 95%CI 0.009–0.978, P=0.048) and vomiting (OR 0.088, 95%CI: 0.017–0.462, P=0.004) were identified as negative predictors of steroid-free clinical remission with statistical significance, with a combined area under the curve of 0.860. Conclusion The piano key sign on IUS was the negative predictor of steroid-free clinical remission. IUS may provide prognostic information for making personalized treatment and monitoring strategies in EoGE patients.