PURPOSE OF THE STUDY.
While eosinophilic esophagitis (EoE) has been well described as an emerging disease in children and adults, the requirement for invasive procedures (ie, endoscopy and biopsies) to diagnose and monitor patients led these investigators to ascertain whether certain noninvasive biomarkers would be useful to differentiate EoE from non-EoE diseases.
Study participants included a cohort of 61 children, mean age 7.5 ± 4.4 years, who were evaluated in a children’s university hospital and diagnosed with EoE. This group was compared with 20 children of similar age who underwent endoscopy but had normal biopsy results.
All participants had baseline measurements of eosinophil activity: serum interleukin-5, serum eosinophil-derived neurotoxin (EDN), and stool EDN. The cohort of children with EoE had repeat measurements of eosinophil activity for up to 24 weeks while being treated with either an inhaled or oral corticosteroid. Corticosteroid treatments consisted of an initial 4-week treatment followed by an 8-week taper and 12-week period off medication.
Serum EDN was significantly higher at baseline in children with EoE compared to normal controls and EDN levels significantly decreased by week 4 in the cohort treated with either inhaled or oral corticosteroids. However, serum EDN did not correlate with either symptom scores or eosinophil density on biopsy at baseline or week 4, and EDN levels did not significantly change from weeks 4 to 24. Serum interleukin-5 and stool EDN levels did not differentiate normal children from children with EoE at baseline.
In a cohort of untreated children with EoE, serum EDN levels were increased compared to normal controls at baseline; however, serum EDN, serum IL-5, or stool EDN at other time points during or after corticosteroid therapy did not correlate with symptom scores or eosinophil density on biopsy.
EoE has gained recognition as a clinical disease distinct from gastroesophageal reflux disease, but the lack of a validated clinical scoring index, the absence of approved drugs for treatment, and the requirement for invasive techniques to diagnose and monitor patients heighten the necessity for noninvasive modalities to monitor patients. Unfortunately, this study is consistent with other studies to date demonstrating that only elevated serum EDN at presentation is a useful noninvasive marker. For now, children may still require repeat endoscopies and biopsies as a disparity remains between eosinophil density and clinical symptoms after initiation of many therapeutic interventions.
- Copyright © 2012 by the American Academy of Pediatrics