Impedance and Histologic Characteristics of the Sub-Laryngeal Esophagus Distinguish Eosinophilic Esophagitis From Other Esophageal Disorders

Choksi, Yash A.; Chaparro, Jasmine; Blanco, Michael; Sharda, Rohit; Sarker, Shabnam; Ferguson, Sarah E.; Higginbotham, Tina; Hiremath, Girish; Revetta, Frank; Washington, M. Kay; Williams, Christopher S.; Vaezi, Michael F.

doi:10.1016/j.cgh.2019.09.032

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…Examples of these include mucosal impedance probes for measuring reflux, the string test for detecting intestinal parasites, the Cytosponge (Medtronic, Minneapolis, Minn) for detecting Barrett esophagus, confocal microscopy, endoscopic functional luminal imaging probe (endoFLIP) for detecting distensibility, transnasal endoscopy, and others, which have now all been repurposed for use in tracking EoE activity and understanding the pathogenesis of EoE. [64][65][66][67][68][69]…”

Section: Researchmentioning

confidence: 99%

Advancing patient care through the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR)

Aceves

Collins

Rothenberg

et al. 2020

Journal of Allergy and Clinical Immunology

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Recent advances in rare disease research are accelerated by the work of consortia that have been supported by the National Institutes of Health. Development of such consortia rely on multidisciplinary relationships and engagement with patient advocacy groups, as well as the National Institutes of Health and industry and academic partners. In this rostrum we present the development of such a process that focuses on eosinophilic gastrointestinal diseases. Principal investigators, patient advocacy groups, research assistants, and trainees work together to perform natural history studies that promote clinical trial readiness tools, conduct clinical trials, train a new generation of investigators, and perform innovative pilot studies.

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Section: Researchmentioning

confidence: 99%

Advancing patient care through the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR)

Aceves

Collins

Rothenberg

et al. 2020

Journal of Allergy and Clinical Immunology

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“…52 More recent analysis of mucosal impedance in EoE shows that the sub-upper esophageal sphincter region of the esophagus seems spared from these changes in mucosal integrity in the setting of EoE. In addition to normal mucosal impedance values in the subupper esophageal sphincter, Choksi et al 53 showed that this region was also spared in large part from histologic findings (intraepithelial eosinophils, dilated intracellular spaces, and basal cell hyperplasia) found in the rest of the active EoE esophagus. 53 Although this procedure is still used for research purposes only, understanding the variation in mucosal integrity along the esophageal body provides novel insight into the pathophysiology of EoE and may lead to more in-depth characterization of patient phenotype.…”

Section: Evaluation Of the Epithelial Integritymentioning

confidence: 99%

EoE disease monitoring

Godwin

Muir

2020

Annals of Allergy, Asthma & Immunology

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The burden of endoscopy in eosinophilic esophagitis (EoE) is great, with many patients undergoing multiple endoscopies to verify treatment success. The gold standard for monitoring disease activity EoE is histologic evaluation and eosinophil enumeration. Although symptoms have been less reliable to track disease activity, multiple noninvasive methodologies are being investigated to sample the esophageal tissue. A better understanding of disease phenotype, genotype, and transcriptome may lead to more personalized approaches to diagnostics and therapeutics in EoE.

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“…As GERD results in a gradient of injury from distal to proximal, not surprisingly, the characteristic pattern seen in GERD is low MI in the distal esophagus with a gradient/increase as MI is measured more proximally. [37][38][39][40][41]46,47 By contrast, EoE often results in a segmental or patchy distribution of eosinophilia. With MI, this often presents as intermittently low MI in the tubular esophagus, without a clear distal to proximal MI gradient.…”

Section: Patterns Of MImentioning

confidence: 99%

“…With MI, this often presents as intermittently low MI in the tubular esophagus, without a clear distal to proximal MI gradient. 41,42,46,[48][49][50] Patients without GERD or EoE-or those with achalasia-tend to have higher impedance parameters at all sites of measurement. When MI data were utilized in modeling, Patel and colleagues reported that the MI intercept (distal MI measurement) and slope (change in MI over distance) could reliably separate patients with GERD (the area under the curve (AUC) 0.67) and EoE (AUC = 0.84) from controls, raising the possibility that results could be automated in a formulaic fashion to aid in real-time diagnosis.…”

Section: Patterns Of MImentioning

confidence: 99%

Mucosal impedance for esophageal disease: evaluating the evidence

Clarke

Ahuja

Chan

et al. 2020

Annals of the New York Academy of Sciences

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Impedance has traditionally been employed in esophageal disease as a means to assess bolus flow and reflux episodes. Recent and ongoing research has provided new and novel applications for this technology. Measurement of esophageal mucosal impedance, via either multichannel intraluminal impedance catheters or specially designed endoscopically deployed impedance catheters, provides a marker of mucosal integrity. Mucosal impedance has been shown to segregate gastroesophageal reflux disease (GERD) and eosinophilic esophagitis from non‐GERD controls and may play a role in predicting response to reflux intervention. More data are needed with regard to other esophageal subgroups, outcome studies, and functional disease. Our paper reviews the history of impedance in esophageal disease, the means of assessing baseline and mucosal impedance, data with regard to the newly developed mucosal impedance probes, the clinical utility of mucosal impedance in specific clinical conditions, and limitations in our existing knowledge, along with suggestions for future studies.

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Impedance and Histologic Characteristics of the Sub-Laryngeal Esophagus Distinguish Eosinophilic Esophagitis From Other Esophageal Disorders

Cited by 8 publications

References 28 publications

Advancing patient care through the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR)

Advancing patient care through the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR)

EoE disease monitoring

Mucosal impedance for esophageal disease: evaluating the evidence

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