期刊
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
卷 18, 期 7, 页码 1475-+出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cgh.2019.08.055
关键词
Esophagus; Epithelium; Inflammation; Prognostic Factor; Outcome
资金
- National Institutes of Health [T32 DK007066, R01DK114436, K01DK103953, R03DK118304, K08DK106444, K08DK099379, K23DK90073]
- Molecular Pathology and Imaging Core
- Host-Microbial Analytic and Repository Core and Cell Culture
- iPS Core Facilities at the National Institutes of Health/National Institute of Diabetes and Digestive Kidney Diseases Center of Molecular Studies in Digestive and Liver Diseases [P30-DK050306]
- Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) [U54AI117804]
- National Institute of Allergy and Infectious Diseases
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Center for Advancing Translational Sciences
- American Partnership for Eosinophilic Disorders
- Campaign Urging Research for Eosinophilic Disorders
- Eosinophilic Family Coalition
- CEGIR Trainee Award
- NASPGHAN FOUNDATION/Takeda Pharmaceutical Products Inc.
- Research Innovation Award
- University of Pennsylvania Center for Molecular Studies in Digestive and Liver Diseases Pilot and Feasibility Grants
BACKGROUND & AIMS: Although eosinophil count is the standard used to monitor disease activity in patients with eosinophilic esophagitis (EoE), there are often disparities between patient-reported symptoms and eosinophil counts. We examined the prevalence of epithelial alterations, namely basal cell hyperplasia (BCH) and spongiosis, among patients with inactive EoE (eosinophil counts below 15 following therapy) and aimed to determine whether maintenance of these changes in epithelial morphology are associated with persistent clinical findings. METHODS: Esophageal biopsies of 243 patients (mean age, 16.9 years) undergoing routine endoscopy at the University of Pennsylvania were evaluated for epithelial BCH and spongiosis. Univariable analysis was used to calculate the association between epithelial changes and symptoms as well as endoscopic findings and peak eosinophil count. We validated our findings using data from a cohort of patients at the University of North Carolina. RESULTS: The discovery and validation cohorts each included patients with inactive EoE, based on histologic factors, but ongoing BCH and spongiosis. Ongoing BCH, but not spongiosis, in patients with inactive EoE was associated with symptoms (odds ratio, 2.14; 95% CI, 1.03-4.42; P = .041) and endoscopic findings (odds ratio, 7.10; 95% CI, 3.12-16.18; P < .001). CONCLUSIONS: In patients with EoE, the presence of BCH might indicate ongoing disease activity, independent of eosinophil count. This might account for the persistent symptoms in patients who are considered to be in remission based on histologic factors.
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