Diet therapy for eosinophilic esophagitis

Vashi, Ronak; Hirano, Ikuo

doi:10.1097/mog.0b013e328362285d

Cited by 14 publications

(12 citation statements)

References 15 publications

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“…The strong correlation of the genes we investigated with eosinophil frequency suggests that the Wnt family pathway might be predictive of EoE severity. Clinically, the presence of eosinophils in EoE has been used as a diagnostic marker for therapeutic efficacy in both steroid or dietary therapy studies . Our findings, demonstrating a clear correlation between Wnt‐associated pathway gene expression and the frequency of eosinophils in the biopsy from the same patient would suggest that these genes are potential biomarkers for EoE.…”

Section: Discussionmentioning

confidence: 52%

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Dysregulation of the Wnt pathway in adult eosinophilic esophagitis

et al. 2014

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Eosinophilic esophagitis (EoE) is a chronic inflammatory disease characterized pathologically by eosinophil infiltration. In addition to loss of barrier integrity, a dominant T Helper 2-associated immune response and strong allergic connection, the esophagus tissue undergoes dramatic changes, with frequent presence of mucosal rings, strictures, linear furrows, and trachealization. Although the inflammatory mechanisms behind this disease are being increasingly well understood, the structural features remain unexplained. We examined the expression of key members of the Wnt-signaling pathway in biopsies from patients with EoE. This pathway has been shown to be critically important in regulating cellular homeostasis, growth, and differentiation and to be dysregulated in several disease conditions. Biopsies from adult EoE patients were collected by endoscopy and mRNA extracted. After cDNA synthesis, the relative gene expression from key upstream (secreted frizzled-related protein 1) and downstream (c-myc and Cyclin D1) molecules in the Wnt pathway, as well as several Wnt pathway members (Wnt1, Axin1, low-density lipoprotein receptor-related protein 6, glycogen synthase kinase 3 beta, and β-catenin), were determined. Biopsies from patients with EoE displayed significantly higher expression of secreted frizzed-related protein 1 than controls, as well as reductions in Cyclin D1 and c-myc. In contrast, there were no differences in the Wnt pathway molecules. The levels of expression of Cyclin D1 and c-myc, as well as β-catenin, in EoE patients showed strong correlations with the frequency of esophageal eosinophils. Our findings suggest that although there are no changes in the overall levels of key Wnt pathway genes in adult EoE, there is evidence for dysregulation of upstream and downstream regulators of Wnt signaling. Importantly, the associations with eosinophilia suggest that these may participate in the pathogenesis of this disease and be markers of disease severity.

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Section: Discussionmentioning

confidence: 52%

“…EoE represents an increasingly prevalent disorder in both children and adults, and there are few treatment options available . In recent years, studies have begun to elucidate mechanisms likely behind the pathology, including role of allergic triggers and Th2‐associated immune responses .…”

Section: Discussionmentioning

confidence: 99%

Dysregulation of the Wnt pathway in adult eosinophilic esophagitis

et al. 2014

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“…As noted previously, dietary therapy is effective, but the generally austere nature of these diets limits patient acceptance, particularly in adults (Vashi and Hirano, 2013). Corticosteroids, such as fluticasone and budesonide, which have low oral bioavailability, are used as a means for topical therapy, which minimizes systemic toxicity (Friend, 1998).…”

Section: Treatmentmentioning

confidence: 97%

Allergic Inflammatory Diseases of the Gastrointestinal Tract

Prussin

2015

Mucosal Immunology

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“…Three dietary modification techniques predominate: i) the elemental diet, ii) the six-food elimination diet (SFED) and iii) an allergy testing-directed elimination diet [2,22]. The elemental diet is the most restrictive, limiting patients to the sole consumption of an amino acid-based formula.…”

Section: Dietary Modificationmentioning

confidence: 99%

Emerging drugs for eosinophilic esophagitis

Kern

Hirano

2013

Expert Opinion on Emerging Drugs

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No FDA-approved prescription medications are currently available for EoE patients. Although a number of novel agents are being developed and tested, Phase III clinical trials are scarce. Since EoE is a newly described disease, physicians have an incomplete understanding of the disease's pathogenesis, natural history and disease manifestations. This has led to significant difficulties in determining the most appropriate endpoints of therapy. Clinical trials are hampered by the lack of an accepted, standardized disease activity measure or biomarker by which therapeutic efficacy is assessed. Effective and approved pharmaceutical therapies are eagerly awaited by both physicians and patients for this increasingly recognized and clinically important disease.

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Diet therapy for eosinophilic esophagitis

Cited by 14 publications

References 15 publications

Dysregulation of the Wnt pathway in adult eosinophilic esophagitis

Dysregulation of the Wnt pathway in adult eosinophilic esophagitis

Allergic Inflammatory Diseases of the Gastrointestinal Tract

Emerging drugs for eosinophilic esophagitis

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