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

Abstract

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.

A prospective open clinical trial of a proton pump inhibitor, elimination diet and/or budesonide for eosinophilic oesophagitis

“…Previous data however have demonstrated a poor correlation between these features and eosinophil count at biopsy . Admittedly, ongoing work in refining these relationships shows promise . Finally, ideally all patient groups would have been followed – up for a longer interval (at least for 9 months as for patients receiving the elimination diet).…”

Systematic review of histological remission criteria in eosinophilic esophagitis

“…Of the 22 studies selected from European centers, 12 studies (55%) considered values within the range 11 to ≤15 eosinophils/hpf 17, 36, 37, 38, 39, 46, 47, 53, 54, 55, 56, 57, 58 as histological remission, and 4 studies (23%) defined histological remission as less than 5 or ≤ 5 eosinophils/hpf 30, 33, 42, 45. Strikingly, all studies conducted in Switzerland used a more stringent and consistent end‐point of <5 eosinophils /hpf to identify cases of histological remission 28, 59, 60…”

A visual analogue scale and a Likert scale are simple and responsive tools for assessing dysphagia in eosinophilic oesophagitis

“…This point remains particularly salient given the increased cost and inconsistent results of more invasive measures to assess EoE disease activity. 40,41 …”