Min Steve B, Nylund Cade M, Baker Thomas P, Ally Mazer, Reinhardt Brian, Chen Yen-Ju, Nazareno Luz, Moawad Fouad J
Departments of *Pediatrics §Medicine, Gastroenterology Service ∥Research Programs, Walter Reed National Military Medical Center Departments of †Pediatrics ¶Medicine, Uniformed Services University of the Health Sciences, Bethesda ‡Joint Pathology Center, Defense Health Agency, Silver Spring, MD.
J Clin Gastroenterol. 2017 Feb;51(2):127-135. doi: 10.1097/MCG.0000000000000621.
The diagnosis and management of eosinophilic esophagitis (EoE) often requires multiple endoscopies. Serum biomarkers can be elevated in EoE patients, but their clinical utility in diagnosis and assessing response to treatment is not well established.
To evaluate serum biomarkers in EoE subjects compared with controls and assess longitudinally in response to treatment.
We conducted a prospective cohort study of children and adults undergoing esophagogastroduodenoscopy for suspected EoE. After completing an 8-week course of proton-pump inhibitor therapy, esophageal mucosal biopsies were obtained, as well as, serum analysis of absolute eosinophil count (AEC), eotaxin-3, eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP) and interleukin-5. Subjects with normal endoscopic and histologic findings constituted controls. Those meeting criteria for EoE underwent repeat esophagogastroduodenoscopy and biomarker measurements following treatment with topical steroids for 8 weeks.
Median levels of AEC (263.50 vs. 102 cu/mm, P<0.001), ECP (26.98 vs. 5.20 ng/mL, P<0.001) and EDN (31.70 vs. 14.18 ng/mL, P=0.004) were significantly elevated in EoE subjects compared with controls and correlated with esophageal eosinophilia. Levels of AEC (odds ratio, 1.79; 95% confidence interval, 1.28-2.64) and ECP (odds ratio, 1.61; 95% confidence interval, 1.23-2.36) were associated with a diagnosis of EoE. Among the 5 biomarkers evaluated, only AEC significantly predicted esophageal eosinophilia following topical steroid therapy in EoE subjects (P=0.006).
AEC, ECP, and EDN were higher in EoE subjects compared with controls and correlated with degree of esophageal eosinophilia. Furthermore, AEC predicted post-treatment eosinophilia, suggesting a potential role in monitoring EoE disease activity.
嗜酸性粒细胞性食管炎（EoE）的诊断和管理通常需要多次内镜检查。EoE患者的血清生物标志物可能会升高，但其在诊断和评估治疗反应方面的临床效用尚未明确。
评估EoE受试者与对照组相比的血清生物标志物，并纵向评估治疗反应。
我们对因疑似EoE接受食管胃十二指肠镜检查的儿童和成人进行了一项前瞻性队列研究。在完成8周的质子泵抑制剂治疗疗程后，获取食管黏膜活检样本，并对血清进行绝对嗜酸性粒细胞计数（AEC）、嗜酸性粒细胞趋化因子-3、嗜酸性粒细胞衍生神经毒素（EDN）、嗜酸性粒细胞阳离子蛋白（ECP）和白细胞介素-5分析。内镜和组织学检查结果正常的受试者作为对照组。符合EoE标准的受试者在接受局部类固醇治疗8周后进行重复食管胃十二指肠镜检查和生物标志物测量。
与对照组相比，EoE受试者的AEC（263.50对102立方毫米，P<0.001）、ECP（26.98对5.20纳克/毫升，P<0.001）和EDN（31.70对14.18纳克/毫升，P=0.004）中位数水平显著升高，且与食管嗜酸性粒细胞增多相关。AEC（比值比，1.79；95%置信区间，1.28 - 2.64）和ECP（比值比，1.61；95%置信区间，1.23 - 2.36）水平与EoE诊断相关。在评估的5种生物标志物中，只有AEC能显著预测EoE受试者局部类固醇治疗后的食管嗜酸性粒细胞增多（P=0.006）。
与对照组相比，EoE受试者的AEC、ECP和EDN水平更高，且与食管嗜酸性粒细胞增多程度相关。此外，AEC可预测治疗后嗜酸性粒细胞增多，提示其在监测EoE疾病活动中可能发挥作用。
