Discrepancy Between Clinical Symptoms and Endoscopic Severity in Eosinophilic Esophagitis: A Retrospective Analysis

Background Eosinophilic esophagitis (EoE) presents with a wide range of clinical symptoms and endoscopic abnormalities. The correlation between clinical symptoms and endoscopic severity remains inconsistent. Objective To assess the relationship between presenting symptoms and endoscopic severity in patients diagnosed with EoE. Methods This retrospective study included patients diagnosed with EoE at Prince Sultan Military Medical City, Riyadh, Saudi Arabia, between 2011 and 2021. Symptom profiles and endoscopic findings were analyzed using the validated EREFS scoring system. Mann-Whitney U tests and multivariate regression were used to determine statistical significance. Results A total of 41 patients were included. Dysphagia was the most common symptom (53.7%), followed by abdominal pain (29.3%). The median EREFS score was 3.0 (IQR: 2.0–5.0). Nausea and vomiting were associated with significantly lower endoscopic scores (mean EREFS: 2.0 vs. 3.94, p = 0.015). On multivariate analysis, nausea and vomiting remained independently associated with lower EREFS scores (β = -1.80, p = 0.048). Conclusion Clinical symptoms, particularly nausea and vomiting, do not reliably predict endoscopic severity in EoE. Endoscopic assessment remains essential for accurate disease evaluation and monitoring.