Higher Body Mass Index Is Associated With Decreased Treatment Response to Topical Steroids in Eosinophilic Esophagitis

Ketchem, Corey J.; Ocampo, Adolfo A.; Xue, Zeyun; Chang, Nicole C.; Thakkar, Kisan; Reddy, Sumana; Greenberg, Sydney B.; Lee, Chris; Redd, Walker D.; Eluri, Swathi; Reed, Craig C.; Dellon, Evan S.

doi:10.1016/j.cgh.2022.11.004

Cited by 12 publications

(8 citation statements)

References 55 publications

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“…Obesity has been identified as a risk factor for EoE in population studies and animal models, 59,60 and obese EoE patients may be less responsive to topical GC. 61 However, studies in established EoE cases indicate that a lower BMI is associated with narrowing, a reduced response to PPI and an increased need for repeat dilation. [62][63][64] The reasons for this apparent discrepancy are unclear and may reflect the relative prevalence of distinct EoE phenotypes.…”

Section: Discussionmentioning

confidence: 99%

Changes in IgG4 and IL-10 expression in adults with eosinophilic esophagitis on a two-food elimination diet

Santonicola

Appanna

Gargano

et al. 2023

Preprint

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Background: Eosinophilic esophagitis (EoE) is increasingly diagnosed in patients with dysphagia and upper gastroenteric symptoms. Elimination diets and/or pharmacologic agents may accomplish temporary remission, but long-term control is challenging. Type-2 immunity to ingested antigens can induce EoE histopathology via non-IgE-dependent mechanisms, possibly involving IgG4 and IL-10 production. To elucidate the contribution of IgG4- and IL-10-producing cells to EoE pathogenesis, we examined their frequencies and association with clinical and histologic endpoints in adult EoE patients given a two-food elimination diet (TFED). Methods: Sixteen patients with EoE were prescribed a TFED. Biopsies collected at baseline and follow-up were used for immunofluorescent detection of IgG4- and IL-10-expressing cells and serum food-specific IgG4 were measured. All variables were correlated with established histologic measures of disease activity. Results: Patients exhibited significant clinical improvement and significant reduction in esophageal eosinophilia and overall histology. A significant decrease in the frequencies of IL-10-expressing cells was also observed, which correlated with histologic changes. In contrast, a concomitant decline in serum and esophageal IgG4, while substantial, did not correlate with IL-10 -cell frequencies or any histologic parameter of EoE activity. Conclusions: The close association of esophageal IL-10 expression with histologic features and their changes after a TFED suggests a critical role of this cytokine in EoE pathogenesis. Conversely, IgG4 serum and mucosal expression, while reflecting the level of exposure to relevant food antigens, is not obviously related to EoE histopathology or IL-10 expression. Studies are needed to characterize IL-10 cellular sources and their functions in EoE progression and treatment response.

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Section: Discussionmentioning

confidence: 99%

Changes in IgG4 and IL-10 expression in adults with eosinophilic esophagitis on a two-food elimination diet

Santonicola

Appanna

Gargano

et al. 2023

Preprint

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“…Prediction of treatment response related to tCS is an area of active research. Nonresponse has been associated with esophageal dilation (42–44), severe esophageal narrowing (45), increased BMI (30), younger age (31,44), and molecular features (46,47). In our analysis, the lower response rate in non-Whites persisted despite adjusting for these other known factors related to tCS response.…”

Section: Discussionmentioning

confidence: 99%

“…At our center, tCS for EoE are prescribed per clinical protocol and can include either swallowed fluticasone (typically from an inhaler) or budesonide (mixed into a slurry from the aqueous formulation), with dosing dependent on patient age and size. The initial course is usually 2-3 months, and then, response is assessed on follow-up endoscopy and biopsy (30,31).…”

Section: Methodsmentioning

confidence: 99%

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Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

Ocampo,

Xue,

Chang

et al. 2023

Am J Gastroenterol

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Introduction: Differences in EoE presentation and outcomes by ethnicity or race remain understudied. We aimed to determine whether EoE patients of Hispanic/Latinx ethnicity or non-White race have differences in presentation at diagnosis or response to topical corticosteroid (tCS) treatment. Methods: This retrospective cohort study included subjects of any age with a new diagnosis of EoE and documentation of ethnicity or race. For those who had treatment with tCS and follow-up endoscopy/biopsy, we assessed histologic response (<15 eosinophils/hpf), global symptom response, and endoscopic responses. Hispanic EoE patients were compared to non-Hispanics at baseline, and before and after treatment. The same analyses were repeated for White vs non-Whites. Results: Of 1026 EoE patients with ethnicity data, just 23 (2%) were Hispanic. Most clinical features at presentation were similar to non-Hispanic EoE patients but histologic response to tCS was numerically lower (38% vs 57%). Non-White EoE patients (13%) were younger at diagnosis, had less insurance, lower zip code-level income, shorter symptom duration, more vomiting, less dysphagia and food impaction, fewer typical endoscopic features, and less dilation. Of 475 patients with race data treated with tCS, non-Whites had a significantly lower histologic response rate (41% vs 59%; p=0.01), and odds of histologic response remained lower after controlling for potential confounders (aOR 0.40, 95%CI: 0.19-0.87). Discussion: Few EoE patients at our center were Hispanic, and they had similar clinical presentations as non-Hispanics. The non-White EoE group was larger, and presentation was less dysphagia-specific. Non-White patients were also less than half as likely to respond to tCS.

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“…We conducted a retrospective cohort study of the University of North Carolina (UNC) EoE Clinicopathologic database, the details of which have been previously reported (16)(17)(18). In brief, this database contains demographic, clinical, endoscopic, and histologic information about patients of any age with a new diagnosis of EoE per consensus guidelines (2,19) at the time of diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Feeding Tube Placement, Complications, and Treatment Responses in a Large Eosinophilic Esophagitis Patient Population

Borinsky,

Cameron,

Xue

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Feeding tubes can provide a temporary or long-term solution for nutritional therapy. Little is known regarding the use of feeding tubes in patients with eosinophilic esophagitis (EoE). We sought to describe the characteristics and outcomes in EoE patients requiring tube feeding. Methods: This was a retrospective cohort study of EoE patients at a large tertiary care health system. Demographics, clinical characteristics, and endoscopic findings were extracted from medical records, and patients who had a feeding tube were identified. Patients with and without a feeding tube were compared. Details about the tube, complications, and treatment were extracted. Growth, global symptomatic, endoscopic, and histopathologic (<15 eos/hpf) responses were compared before and after the initiation of feeding tube therapy. Results: We identified 39 of 1216 EoE patients who had a feeding tube (3%). Feeding tube patients were younger (mean age 6.3 years), reported more vomiting, and had a lower total endoscopic reference score than non-feeding tube patients (p<0.01 for all). Tubes were used for therapy for an average of 6.8 years, with most patients (95%) receiving both pharmacologic and formula treatment for EoE. An emergency department visit for a tube complication was required in 26%. Tube feeding improved BMI z-score (p<0.01), symptomatic response (42%), endoscopic response (53%), and histologic response (71%). Conclusions: Among EoE patients, only a small subset required a feeding tube and predominantly were young children with failure to thrive. Feeding tubes significantly improved growth and, when used in combination with other treatments, led to reduced esophageal eosinophilic inflammation.

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Higher Body Mass Index Is Associated With Decreased Treatment Response to Topical Steroids in Eosinophilic Esophagitis

Cited by 12 publications

References 55 publications

Changes in IgG4 and IL-10 expression in adults with eosinophilic esophagitis on a two-food elimination diet

Changes in IgG4 and IL-10 expression in adults with eosinophilic esophagitis on a two-food elimination diet

Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

Feeding Tube Placement, Complications, and Treatment Responses in a Large Eosinophilic Esophagitis Patient Population

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