Alexander Jeffrey A, Ravi Karthik, Symrk Thomas C, Wu Tsung-The, Lavey Crystal J, Geno Debra, Johnson Alyssa J, Lennon Ryan J, Collins Margaret H, Dellon Evan S, Katzka David A
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Clin Gastroenterol Hepatol. 2023 Feb;21(2):299-306.e3. doi: 10.1016/j.cgh.2022.05.029. Epub 2022 Jun 10.
BACKGROUND & AIMS: Dietary therapy is successful in eosinophilic esophagitis (EoE) but requires multiple upper endoscopies. The aim of this study was to determine if food reintroduction in EoE can be directed by minimally-invasive esophageal sponge cytology.
In this prospective non-blinded trial, 22 responders to 6-food elimination diets underwent sequential food reintroduction guided by esophageal sponge cytology. Foods were reintroduced followed by unsedated esophageal sponge cytology assessment. A food trigger was defined by sponge cytology peak eosinophil count of ≥15 eos/high-powered field (hpf). Symptoms (EoE symptom activity index [EEsAI]), endoscopic score (EoE endoscopic reference score [EREFS]), and biopsy histology (peak eosinophil count) were collected pre-dietary therapy and post-dietary therapy, and then 4 weeks post food reintroduction.
The EEsAI and EREFS were similar post-dietary therapy to post-food reintroduction: 12.0 (interquartile range [IQR], 0.0-27.0) vs 16.5 (IQR, 9.0-28.8) (P = .265) and 1.5 (IQR, 0.2-3.0) vs 1.0 (IQR, 0.0-2.0) (P = .185). However, the peak eosinophil count was increased post-food reintroduction compared with post-dietary therapy: 20.0 (IQR, 5.0-51.5) vs 2.0 (IQR, 1.0-4.0) (P < .001), suggesting a failure of identification of all food triggers. The peak eosinophil count was lower post-food reintroduction compared with pre-dietary therapy: 20.0 (IQR, 5.0-51.5) vs 52.0 (IQR, 30.8-76.2) (P = .008). At the post food reintroduction evaluation, sponge cytology and biopsy histology were in agreement in 59% (13/22) of cases using a cutoff of <15 eos/hpf and 68% (15/22) of cases using a cutoff of <6 eos/hpf.
In the first study to evaluate a non-endoscopic technique in the clinical management of EoE, the esophageal sponge was moderately successful at guiding food reintroduction in EoE dietary responders in the outpatient setting.
gov, Number NCT02599558.
饮食疗法对嗜酸性粒细胞性食管炎（EoE）有效，但需要多次上消化道内镜检查。本研究的目的是确定EoE患者的食物重新引入是否可以通过微创食管海绵细胞学检查来指导。
在这项前瞻性非盲试验中，22名对6种食物排除饮食有反应的患者在食管海绵细胞学检查的指导下进行了连续的食物重新引入。重新引入食物后，进行未镇静的食管海绵细胞学评估。食物触发因素定义为海绵细胞学检查中嗜酸性粒细胞峰值计数≥15个/高倍视野（hpf）。在饮食治疗前、饮食治疗后以及食物重新引入后4周收集症状（EoE症状活动指数[EEsAI]）、内镜评分（EoE内镜参考评分[EREFS]）和活检组织学（嗜酸性粒细胞峰值计数）。
饮食治疗后与食物重新引入后的EEsAI和EREFS相似：分别为12.0（四分位间距[IQR]，0.0 - 27.0）和16.5（IQR，9.0 - 28.8）（P = 0.265），以及1.5（IQR，0.2 - 3.0）和1.0（IQR，0.0 - 2.0）（P = 0.185）。然而，与饮食治疗后相比，食物重新引入后嗜酸性粒细胞峰值计数增加：分别为20.0（IQR，5.0 - 51.5）和2.0（IQR，1.0 - 4.0）（P < 0.001），这表明未能识别出所有食物触发因素。与饮食治疗前相比，食物重新引入后嗜酸性粒细胞峰值计数更低：分别为20.0（IQR，5.0 - 51.5）和52.0（IQR，30.8 - 76.2）（P = 0.008）。在食物重新引入评估时，当临界值为<15个/eos/hpf时，海绵细胞学检查与活检组织学检查在59%（13/22）的病例中结果一致；当临界值为<6个/eos/hpf时，在68%（15/22）的病例中结果一致。
在第一项评估非内镜技术在EoE临床管理中的研究中，食管海绵在门诊环境中指导EoE饮食有反应者的食物重新引入方面取得了一定成功。
美国国立医学图书馆临床试验注册中心，编号NCT02599558。
