One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis. (October 2019)

• Record Type: Journal Article
• Authors: Ackerman, Steven J.; Kagalwalla, Amir F.; Hirano, Ikuo; Gonsalves, Nirmala; Katcher, Paul Menard; Gupta, Sandeep; Wechsler, Joshua B.; Grozdanovic, Milica; Pan, Zhaoxing; Masterson, Joanne C.; Du, Jian; Fantus, Robert J.; Alumkal, Preeth; Lee, James J.; Ochkur, Sergei; Ahmed, Faria; Capocelli, Kelley; Melin-Aldana, Hector; Biette, Kathryn; Dubner, Allison; Amsden, Katie; Keeley, Kaitlin; Sulkowski, Maureen; Zalewski, Angelika; Atkins, Dan; Furuta, Glenn T.
• Is Part Of: American journal of gastroenterology. Volume 114:Number 10(2019)
• Publication Date: 2019-10
• Subjects: Stomach -- Diseases -- Periodicals; Intestines -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Gastrointestinal Diseases -- Periodicals; Electronic journals; Periodicals; 616.33
• DOI: 10.14309/ajg.0000000000000371
• Languages: English
• ISSNs: 0002-9270

Abstract

Abstract : OBJECTIVES: Eosinophilic esophagitis (EoE), a chronic food allergic disease, lacks sensitive and specific peripheral biomarkers. We hypothesized that levels of EoE-related biomarkers captured using a 1-hour minimally invasive Esophageal String Test (EST) would correlate with mucosal eosinophil counts and tissue concentrations of these same biomarkers. We aimed to determine whether a 1-hour EST accurately distinguishes active from inactive EoE or a normal esophagus. METHODS: In a prospective, multisite study, children and adults (ages 7–55 years) undergoing a clinically indicated esophagogastroduodenoscopy performed an EST with an esophageal dwell time of 1 hour. Subjects were divided into 3 groups: active EoE, inactive EoE, and normal esophageal mucosa. Eosinophil-associated protein levels were compared between EST effluents and esophageal biopsy extracts. Statistical modeling was performed to select biomarkers that best correlated with and predicted eosinophilic inflammation. RESULTS: One hundred thirty-four subjects (74 children, 60 adults) with active EoE (n = 62), inactive EoE (n = 37), and patient controls with a normal esophagus (n = 35) completed the study. EST-captured eosinophil-associated biomarkers correlated significantly with peak eosinophils/high-power field, endoscopic visual scoring, and the same proteins extracted from mucosal biopsies. Statistical modeling, using combined eotaxin-3 and major basic protein-1 concentrations, led to the development of EoE scores that distinguished subjects with active EoE from inactive EoE or normal esophagi. Eighty-seven percent of children, 95% of parents, and 92% of adults preferred the EST over endoscopy if it provided similar information. DISCUSSION: The 1-hour EST accurately distinguishes active from inactive EoE in children and adults and may facilitate monitoring of disease activity in a safe and minimally invasive fashion.