One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis
One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis
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DOI：
10.14309/ajg.0000000000000371
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发表时间：
2019-10-01
影响因子：
9.8
通讯作者：
Furuta, Glenn T.
中科院分区：
文献类型：
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作者：
Ackerman, Steven J.;Kagalwalla, Amir F.;Furuta, Glenn T.
嗜酸性食管炎（EoE）是一种慢性食物过敏性疾病，缺乏敏感和特异性的外周生物标志物。我们假设，使用1小时微创食管串试验（EST）捕获的EoE相关生物标志物水平与粘膜嗜酸性粒细胞计数和这些相同生物标志物的组织浓度相关。我们的目的是确定是否1小时EST准确区分活跃的非活动性EoE或一个正常的esophageal.METHODS：在一项前瞻性，多地点的研究，儿童和成人（年龄7 - 55岁）进行了临床指征食管胃镜检查进行了EST与食管停留时间为1小时。受试者分为3组：活动性EoE、非活动性EoE和正常食管粘膜。在EST流出物和食管活检提取物之间比较嗜酸性粒细胞相关蛋白水平。进行统计建模，以选择最好的相关性和预测嗜酸性粒细胞inflammation.RESULTS：134例受试者（74名儿童，60名成人）与活动EoE（n = 62），非活动EoE（n = 37），和患者对照组与正常食管（n = 35）完成了研究。EST捕获的嗜酸性粒细胞相关生物标志物与嗜酸性粒细胞峰值/高倍视野、内窥镜视觉评分以及从粘膜活检中提取的相同蛋白质显著相关。使用组合的嗜酸性粒细胞趋化因子-3和主要碱性蛋白-1浓度的统计建模导致EoE评分的发展，该评分将具有活动性EoE的受试者与非活动性EoE或正常食管区分开。百分之八十七的儿童，95%的父母，和92%的成年人喜欢的EST超过endoscopic，如果它提供了类似的information.Discussion：1小时EST准确区分活跃的不活跃的EoE在儿童和成人，并可能有助于监测疾病的活动在一个安全和微创的方式。
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.