Use of the Esophageal Sponge in Directing Food Reintroduction in Eosinophilic Esophagitis.

Humans Biopsy Eosinophilic Esophagitis / diagnosis Eosinophils / pathology Prospective Studies
Eosinophilic Esophagitis Esophageal Sponge Cytology Food Reintroduction

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
02 2023
Historique:
received: 01 03 2022
revised: 18 05 2022
accepted: 26 05 2022
pubmed: 14 6 2022
medline: 28 1 2023
entrez: 13 6 2022
Statut: ppublish

Résumé

Dietary therapy is successful in eosinophilic esophagitis (EoE) but requires multiple upper endoscopies. The aim of this study was to determine if food reintroduction in EoE can be directed by minimally-invasive esophageal sponge cytology. In this prospective non-blinded trial, 22 responders to 6-food elimination diets underwent sequential food reintroduction guided by esophageal sponge cytology. Foods were reintroduced followed by unsedated esophageal sponge cytology assessment. A food trigger was defined by sponge cytology peak eosinophil count of ≥15 eos/high-powered field (hpf). Symptoms (EoE symptom activity index [EEsAI]), endoscopic score (EoE endoscopic reference score [EREFS]), and biopsy histology (peak eosinophil count) were collected pre-dietary therapy and post-dietary therapy, and then 4 weeks post food reintroduction. The EEsAI and EREFS were similar post-dietary therapy to post-food reintroduction: 12.0 (interquartile range [IQR], 0.0-27.0) vs 16.5 (IQR, 9.0-28.8) (P = .265) and 1.5 (IQR, 0.2-3.0) vs 1.0 (IQR, 0.0-2.0) (P = .185). However, the peak eosinophil count was increased post-food reintroduction compared with post-dietary therapy: 20.0 (IQR, 5.0-51.5) vs 2.0 (IQR, 1.0-4.0) (P < .001), suggesting a failure of identification of all food triggers. The peak eosinophil count was lower post-food reintroduction compared with pre-dietary therapy: 20.0 (IQR, 5.0-51.5) vs 52.0 (IQR, 30.8-76.2) (P = .008). At the post food reintroduction evaluation, sponge cytology and biopsy histology were in agreement in 59% (13/22) of cases using a cutoff of <15 eos/hpf and 68% (15/22) of cases using a cutoff of <6 eos/hpf. In the first study to evaluate a non-endoscopic technique in the clinical management of EoE, the esophageal sponge was moderately successful at guiding food reintroduction in EoE dietary responders in the outpatient setting. gov, Number NCT02599558.

Sections du résumé

BACKGROUND & AIMS
Dietary therapy is successful in eosinophilic esophagitis (EoE) but requires multiple upper endoscopies. The aim of this study was to determine if food reintroduction in EoE can be directed by minimally-invasive esophageal sponge cytology.
METHODS
In this prospective non-blinded trial, 22 responders to 6-food elimination diets underwent sequential food reintroduction guided by esophageal sponge cytology. Foods were reintroduced followed by unsedated esophageal sponge cytology assessment. A food trigger was defined by sponge cytology peak eosinophil count of ≥15 eos/high-powered field (hpf). Symptoms (EoE symptom activity index [EEsAI]), endoscopic score (EoE endoscopic reference score [EREFS]), and biopsy histology (peak eosinophil count) were collected pre-dietary therapy and post-dietary therapy, and then 4 weeks post food reintroduction.
RESULTS
The EEsAI and EREFS were similar post-dietary therapy to post-food reintroduction: 12.0 (interquartile range [IQR], 0.0-27.0) vs 16.5 (IQR, 9.0-28.8) (P = .265) and 1.5 (IQR, 0.2-3.0) vs 1.0 (IQR, 0.0-2.0) (P = .185). However, the peak eosinophil count was increased post-food reintroduction compared with post-dietary therapy: 20.0 (IQR, 5.0-51.5) vs 2.0 (IQR, 1.0-4.0) (P < .001), suggesting a failure of identification of all food triggers. The peak eosinophil count was lower post-food reintroduction compared with pre-dietary therapy: 20.0 (IQR, 5.0-51.5) vs 52.0 (IQR, 30.8-76.2) (P = .008). At the post food reintroduction evaluation, sponge cytology and biopsy histology were in agreement in 59% (13/22) of cases using a cutoff of <15 eos/hpf and 68% (15/22) of cases using a cutoff of <6 eos/hpf.
CONCLUSIONS
In the first study to evaluate a non-endoscopic technique in the clinical management of EoE, the esophageal sponge was moderately successful at guiding food reintroduction in EoE dietary responders in the outpatient setting.
CLINICALTRIALS
gov, Number NCT02599558.

Identifiants

DOI: 10.1016/j.cgh.2022.05.029 PMID: 35697266
pubmed: 35697266
pii: S1542-3565(22)00557-2
doi: 10.1016/j.cgh.2022.05.029
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02599558']

Types de publication

Clinical Trial Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

299-306.e3

Informations de copyright

Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.

Auteurs

Jeffrey A Alexander (JA)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: alexander.jeffrey14@mayo.edu.

Karthik Ravi (K)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Thomas C Symrk (TC)

Department of Pathology, Mayo Clinic, Rochester, Minnesota.

Tsung-The Wu (TT)

Department of Pathology, Mayo Clinic, Rochester, Minnesota.

Crystal J Lavey (CJ)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Debra Geno (D)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Alyssa J Johnson (AJ)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Ryan J Lennon (RJ)

Department of Biostatistics, Mayo Clinic, Rochester, Minnesota.

Margaret H Collins (MH)

Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Evan S Dellon (ES)

Department of Gastroenterology, University of North Carolina, Chapel Hill, North Carolina.

David A Katzka (DA)

Department of Gastroenterology, Columbia University Medical Center, New York, New York.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Use of the Esophageal Sponge in Directing Food...
questionsmedicales.fr › Techniques d'investigation › Techniques cytologiques › Cytodiagnostic › Biopsie › Use of the Esophageal Sponge in Directing Food...
questionsmedicales.fr › Maladies du système immunitaire › Hypersensibilité › Hypersensibilité immédiate › Oesophagite à éosinophiles › Use of the Esophageal Sponge in Directing Food...
questionsmedicales.fr › Systèmes sanguin et immunitaire › Système immunitaire › Leucocytes › Granulocytes › Granulocytes éosinophiles › Use of the Esophageal Sponge in Directing Food...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Use of the Esophageal Sponge in Directing Food...