Patient-Reported Outcomes and Blood-Based Parameters Identify Response to Treatment in Eosinophilic Esophagitis

• Published in: Digestive diseases and sciences 2021-05, Vol.66 (5), p.1556-1564
• Main Authors: Lingblom, Christine, Albinsson, Sofie, Johansson, Leif, Larsson, Helen, Wennerås, Christine
• Format: Article
• Language: English
• Subjects: Allergens; Analysis; Autoimmune diseases; B cells; Biochemistry; Biomarker; Biomarkers; Biopsy; Blood donors; Care and treatment; CD16; Clinical Medicine; diagnosis; Disease; Dysphagia; Endoscopy; Eosinophilic esophagitis; Eosinophils; Esophageal diseases; Esophagitis; Esophagus; Ethylenediaminetetraacetic acid; Flow cytometry; Gastroenterology; Gastroenterology & Hepatology; Gastrointestinal diseases; Granulocytes; Health surveys; Hepatology; Klinisk medicin; Lymphocytes; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Multivariate analysis; noninvasive biomarkers; Oncology; Original; Original Article; outcome; Patient outcomes; Patient-reported; Patients; Pattern recognition; Quality of life; Questionnaires; Surveys; symptoms; T cells; Transplant Surgery
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-020-06368-2

Background Noninvasive methods to assess treatment response in eosinophilic esophagitis are needed. Aims Our aim was to determine whether a blood-based biomarker panel centered on immune parameters could identify histologic response to treatment in eosinophilic esophagitis patients. Methods A pilot study involving adult patients with active eosinophilic esophagitis recruited at two Ear, Nose, Throat clinics in Sweden was designed. The patients ( n  = 20) donated blood and esophageal biopsies and filled in three questionnaires before and after a 2-month course of topical corticosteroids. Blood samples were analyzed for absolute levels of granulocytes and T cells and the fractions of eosinophils expressing 10 different surface markers by flow cytometry. All data were analyzed by multivariate methods of pattern recognition. Results Multivariate modeling revealed that a combination of 13 immune parameters and 10 patient-reported outcome scores were required to create a model capable of separating responders ( n  = 15) from non-responders ( n  = 5). Questions regarding symptoms of esophageal dysfunction and capacity to eat certain foods from two of the questionnaires were discriminatory in the multivariate model, as were absolute counts of T cells, eosinophils, and eosinophil expression of activation markers and cell adhesion molecules. Conclusions A combination of blood-based immune parameters and directed questions may prove helpful to monitor response to treatment, perhaps reducing the need for repeat endoscopies in eosinophilic esophagitis patients in the future.