Journal
GUT
Volume 62, Issue 10, Pages 1395-1405Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/gutjnl-2012-303171
Keywords
Eosinophil; pediatric; enterotest string test; oesophagitis; inflammation; epithelial barrier; gastrointestinal tract; oesophageal disease; oesophageal disorders; oesophageal lesions; oesophageal reflux; oesophageal strictures; allergy; breast milk; childhood nutrition
Categories
Funding
- Thrasher Research Fund
- NIH/NCATS Colorado CCTSI [UL1 TR000154]
- Shell
- Mandell
- Boyd
- Savoie Families
- American Gastroenterological Association
- Campaign Urging Research for Eosinophilic Diseases
- Buckeye Foundation
- Pappas Foundation
- American Partnership for Eosinophilic Disorders
- Sandhill Scientific
- Mayo Foundation
- NIH [HL058732]
- NCRR [K26 RR0109709]
- [NIH-R21AI079925]
- [NIH-1UL1RR025741]
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Objective Eosinophil predominant inflammation characterises histological features of eosinophilic oesophagitis (EoE). Endoscopy with biopsy is currently the only method to assess oesophageal mucosal inflammation in EoE. We hypothesised that measurements of luminal eosinophil-derived proteins would correlate with oesophageal mucosal inflammation in children with EoE. Design The Enterotest diagnostic device was used to develop an oesophageal string test (EST) as a minimally invasive clinical device. EST samples and oesophageal mucosal biopsies were obtained from children undergoing upper endoscopy for clinically defined indications. Eosinophil-derived proteins including eosinophil secondary granule proteins (major basic protein-1, eosinophil-derived neurotoxin, eosinophil cationic protein, eosinophil peroxidase) and Charcot-Leyden crystal protein/galectin-10 were measured by ELISA in luminal effluents eluted from ESTs and extracts of mucosal biopsies. Results ESTs were performed in 41 children with active EoE (n=14), EoE in remission (n=8), gastro-oesophageal reflux disease (n=4) and controls with normal oesophagus (n=15). EST measurement of eosinophil-derived protein biomarkers significantly distinguished between children with active EoE, treated EoE in remission, gastro-oesophageal reflux disease and normal oesophagus. Levels of luminal eosinophil-derived proteins in EST samples significantly correlated with peak and mean oesophageal eosinophils/high power field (HPF), eosinophil peroxidase indices and levels of the same eosinophil-derived proteins in extracts of oesophageal biopsies. Conclusions The presence of eosinophil-derived proteins in luminal secretions is reflective of mucosal inflammation in children with EoE. The EST is a novel, minimally invasive device for measuring oesophageal eosinophilic inflammation in children with EoE.
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