An allergic phenotype and the use of steroid inhalers predict eosinophilic oesophagitis in patients with asthma

Harer, Kimberly; Enders, Felicity; Lim, Kaiser G.; Alexander, Jeffrey A.; Katzka, David A.

doi:10.1111/apt.12131

Cited by 19 publications

(9 citation statements)

References 17 publications

(19 reference statements)

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“…It has already been postulated that the level of peripheral blood eosinophils holds promise as an EoE biomarker, although the incidences of peripheral blood eosinophilia in EoE patients (defined as 300/mm 3 ) might vary and be particularly influenced by confounders such as the role of seasons or concomitant atopic conditions . A significant correlation of blood eosinophilia with oesophageal eosinophil tissue infiltration has been reported in several studies and an increased blood eosinophil number has even been proposed as a predictive marker of EoE . However, so far only a few studies have systematically evaluated the value of blood eosinophils for monitoring treatment of EoE.…”

Section: Discussionmentioning

confidence: 99%

Peripheral blood eosinophils and other non‐invasive biomarkers can monitor treatment response in eosinophilic oesophagitis

Schlag

Miehlke

Heiseke

et al. 2015

Aliment Pharmacol Ther

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Summary Background Monitoring of the treatment response in eosinophilic oesophagitis (EoE) requires structured endoscopical and histological examination of the oesophagus. Less invasive methods would be highly desirable. Aim To evaluate the utility of several EoE‐associated blood and serum markers in order to non‐invasively monitor the response to treatment with swallowed topical corticosteroids in adult EoE patients. Methods In a randomised, controlled double‐blind trial blood samples of EoE patients (n = 69) were collected at baseline and after 14 days of treatment with budesonide (n = 51) or placebo (n = 18) respectively. Absolute blood eosinophil count (AEC) as well as serum levels of CCL‐17, CCL‐18, CCL‐26, eosinophil‐cationic‐protein (ECP) and mast cell tryptase (MCT) were determined and correlated with oesophageal eosinophil density and with symptom and endoscopy scores. Results Histological remission, defined as mean number of <16 eos/mm2 hpf at end‐of‐treatment, was achieved in 98% of the budesonide and 0% of the placebo recipients. AEC [380.2 vs. 214.7/mm3 (P = 0.0001)], serum‐CCL‐17 [294.3 vs. 257.9 pg/mL (P = 0.0019)], ‐CCL‐26 [26.7 vs. 16.2 pg/mL (P = 0.0058)], ‐ECP [45.5 ± 44.7 vs. 27.5 ± 25.0 μg/L (P = 0.0016)] and ‐MCT [5.3 ± 2.9 vs. 4.5 ± 2.6 μg/L (P = 0.0019)] significantly decreased under budesonide but not under placebo. AEC significantly correlated with oesophageal eosinophil density before (r = 0.28, P = 0.0236) and after (r = 0.42, P = 0.0004) budesonide treatment. In ROC‐AUC analyses post‐treatment values of AEC were significantly associated with histological remission (ROC‐AUC 0.754; 95% CI: 0.617–0.891; P = 0.0003). Conclusions The budesonide‐induced treatment response in EoE is mirrored by several blood and serum markers, and the absolute blood eosinophil count is the most valuable as it shows correlation with the oesophageal eosinophil density.

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Section: Discussionmentioning

confidence: 99%

Peripheral blood eosinophils and other non‐invasive biomarkers can monitor treatment response in eosinophilic oesophagitis

Schlag

Miehlke

Heiseke

et al. 2015

Aliment Pharmacol Ther

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“…In a single adult study, use of corticosteroid inhalers for the treatment of asthma was reported as having a protective effect on the development of eosinophilic esophagitis. The authors acknowledged that this may not be a true protective effect but rather inadvertent treatment of eosinophilic esophagitis if inhalers are used incorrectly (swallowed instead of inhaled) . Therefore, when interpreting esophageal biopsies or improvement in symptoms in patients taking PPIs or inhaled steroids, it is critical to understand the impact these therapies may have on EoE and how they could interfere with making the correct diagnosis.…”

Section: Role Of Empiric Therapiesmentioning

confidence: 99%

“…Proposed algorithm for patients with refractory respiratory symptoms undergoing laryngoscopy or bronchoscopy RUBINSTEIN AND ROSEN | 1589 esophagitis if inhalers are used incorrectly (swallowed instead of inhaled) 29. Therefore, when interpreting esophageal biopsies or improvement in symptoms in patients taking PPIs or inhaled steroids, it is critical to understand the impact these therapies may have on EoE and how they could interfere with making the correct diagnosis.…”

mentioning

confidence: 99%

Respiratory symptoms associated with eosinophilic esophagitis

Rubinstein

Rosen

2018

Pediatric Pulmonology

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Eosinophilic esophagitis (EoE) is an atopic condition diagnosed based on eosinophilic infiltration in the esophagus and symptoms of esophageal dysfunction. Typical clinical manifestations of EoE include feeding refusal, vomiting, and dysphagia however recent reports highlight an associations with extraesophageal symptoms. By definition the inflammatory response in EoE is restricted to the esophagus. However, accounts of symptoms such as chronic refractory cough, recurrent croup, hoarseness as well as subglottic stenosis, and an increase in otolaryngologic surgeries in patients with EoE raise the possibility of extraesophageal manifestations of the disease. These symptoms have been reported at times in the absence of typical gastrointestinal symptoms. While the condition is usually managed by gastroenterologist and/or allergist, the presence of extraesophageal symptoms and comorbid conditions may result in patients presenting initially to providers in other subspecialties such as pulmonology and otorhinolaryngology. The use of proton pump inhibitors and corticosteroids are part of the management of EoE. Awareness of the possibility of EoE before the empiric use of these therapies is important as there use can make identifying and diagnosing patients with EoE correctly challenging. We review the medical literature regarding extraesophageal manifestations of EoE and highlight the importance of awareness for subspecialist outside of gastroenterology and allergy for the condition.

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“…We also detected new pleural nerve connectivity to vessels and airways, derivation from airways, wrapping around from dorsal to ventral surfaces. Our method also found novel connections between the distal esophagus and inferior lungs via the mediastinal fascia that may relate to the association between airway disease (e.g., asthma and cough) and esophageal disease (e.g., eosinophilic esophagitis, reflux) (25)(26)(27)(28)(29)(30). The inability to image the whole lung and esophagus in prior studies likely led to undersampling, which explains differing conclusions about the distribution of visceral pleural nerves seen in these previous studies (23,24,31).…”

Section: Whole Lung Imaging Of Visceral Pleural Innervationmentioning

confidence: 99%

Tissue Optical Clearing, Three-Dimensional Imaging, and Computer Morphometry in Whole Mouse Lungs and Human Airways

Scott

Blum

Fryer

et al. 2014

Am J Respir Cell Mol Biol

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In whole adult mouse lung, full identification of airway nerves (or other cellular/subcellular objects) has not been possible due to patchy distribution and micron-scale size. Here we describe a method using tissue clearing to acquire the first complete image of threedimensional (3D) innervation in the lung. We then created a method to pair analysis of nerve (or any other colabeled epitope) images with identification of 3D tissue compartments and airway morphometry by using fluorescent casting and morphometry software (which we designed and are making available as open-source). We then tested our method to quantify a sparse heterogeneous nerve population by examining visceral pleural nerves. Finally, we demonstrate the utility of our method in human tissue to image full thickness innervation in irregular 3D tissue compartments and to quantify sparse objects (intrinsic airway ganglia). Overall, this method can uniquely pair the advantages of whole tissue imaging and cellular/subcellular fluorescence microscopy.

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An allergic phenotype and the use of steroid inhalers predict eosinophilic oesophagitis in patients with asthma

Abstract: SUMMARY BackgroundPatients with eosinophilic oesophagitis (EoE) commonly have asthma and atopy.

Cited by 19 publications

References 17 publications

Peripheral blood eosinophils and other non‐invasive biomarkers can monitor treatment response in eosinophilic oesophagitis

Peripheral blood eosinophils and other non‐invasive biomarkers can monitor treatment response in eosinophilic oesophagitis

Respiratory symptoms associated with eosinophilic esophagitis

Tissue Optical Clearing, Three-Dimensional Imaging, and Computer Morphometry in Whole Mouse Lungs and Human Airways

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