Simple Test May Ease Management of Eosinophilic Esophagitis

A
 simple
 new 
test,
 in
 which
 the 
patient 
swallows 
a 
string, 
can 
monitor 
treatment 
of 
 eosinophilic 
esophagitis 
as 
effectively 
as 
an 
invasive, 
expensive 
and 
uncomfortable 
procedure 
that 
risks 
complications, 
particularly
 in 
children.

Researchers
 from
 the 
University 
of 
Illinois 
at 
Chicago
 College 
of 
Medicine, 
the
 University 
of 
Colorado
 Denver 
School 
of
 Medicine/Children’s 
Hospital 
Colorado 
and
 Lurie 
Children’s 
Hospital/Northwestern
 University
 in 
Chicago 
reported 
their
 findings 
in 
a 
study 
published
 recently
 online
 in 
the
 journal 
Gut.

Eosinophilic 
esophagitis, 
or 
EoE,
 is 
a 
food‐allergy
 inflammatory 
disease 
of 
the
 esophagus 
in 
both 
children 
and
 adults. 
While 
rare, 
it 
is 
steadily 
increasing 
in
 incidence. 
In 
EoE, 
inflammatory 
cells
 in 
the 
body 
called 
eosinophils 
attack
 the
 esophagus. 

In 
some 
patients, 
the 
esophagus 
narrows
 until 
food
 cannot
 pass, 
causing
 painful 
food 
impactions.

“Many 
cases 
are 
first 
encountered 
in 
the 
emergency 
room, 
where 
a 
child
 is 
brought
 in 
because 
something 
he 
ate 
is 
stuck
 in 
his 
esophagus,” 
says 
Steven 
Ackerman, 
UIC
 professor 
of 
biochemistry 
and 
molecular 
genetics 
and 
co‐principal
 investigator 
on
 the 
study.

Eosinophils 
produce
 specific 
proteins.
 Because
 these
 inflammatory
 cells 
are
 not
 normally 
found 
in 
the 
esophagus, 
these 
proteins 
can 
serve 
as 
biomarkers 
and 
can
 indicate 
the 
extent 
of 
inflammation 
in 
the 
esophagus.

Currently, 
physicians 
diagnose 
EoE 
and 
monitor 
its 
treatment 
by 
endoscopy. 
A
 lighted, 
flexible 
instrument 
is 
inserted 
down 
the 
esophagus
 and 
used 
to 
obtain
 biopsy 
tissue 
samples 
along 
its 
length, 
from 
top to 
bottom.

A 
child 
may
 require 
a 
number 
of
 endoscopies 
with
 biopsy as physicians seek to establish
 an 
effective 
treatment, 
say 
two 
of 
the 
report’s 
authors, 
co‐principal
 investigator
 Dr. 
Glenn 
Furuta, 
professor
 of 
pediatrics
 at 
the 
University
 of 
Colorado 
at 
Denver,
 and 
Dr. 
Amir 
Kagalwalla, 
associate 
professor
 of
 pediatrics 
at 
Northwestern
 University.

The 
new 
method, 
the 
Esophageal 
String 
Test, 
or 
EST, 
uses 
a 
capsule 
containing
 a
 yard‐long 
string. 
One 
end 
of 
the 
string
 is 
taped
 to
 the 
patient’s 
cheek 
before 
the
 capsule 
is 
swallowed, 
and 
the 
string
 spools 
out 
of 
the 
capsule 
as 
it 
passes 
through
 the 
gastrointestinal
 tract, 
stretching 
through
 the
 esophagus,
 the
 stomach 
and
 the
 upper 
region 
of 
the 
small 
intestine.
 The 
string
 becomes
 coated
 with
 digestive 
tract
 secretions
 and
 can
 be
 removed 
for 
analysis.

Ackerman 
and 
Furuta
 tested 
samples 
from
 the
 string 
in 
the 
esophagus 
region,
 looking 
for 
eosinophil 
proteins 
to 
show
 evidence 
of 
inflammation.
 Levels 
detected
 by 
the
 string 
test 
and 
by 
biopsy 
were 
both 
shown 
to 
indicate 
disease 
accurately.

The 
researchers 
recruited
 41 
patients 
ages 
7 to 20, 
who
 were 
to 
undergo 
endoscopy
 and 
biopsy. 
Participants 
swallowed
 the 
capsule 
the 
night 
before 
endoscopy, 
and 
the
 string 
was 
removed 
just 
prior 
to 
that 
procedure. 
The 
researchers 
believe
 the 
string
 may 
not 
need
 to 
remain 
in 
place
 for 
so 
long, 
and 
the 
test 
could
 be 
performed 
in 
a
 single 
visit 
to 
the 
doctor’s 
office.

Although 
the 
string
 test 
may 
never 
completely 
replace 
endoscopy‐with‐biopsy,
 particularly 
for 
diagnosis, 
”it 
certainly
 has 
the
 potential 
to
 significantly 
improve 
the 
evaluation
 and 
treatment
 of 
patients
 who 
require 
repeated
 assessments,”

 the 
authors 
conclude.

The 
study 
was 
supported 
by 
grants 
or 
gifts 
from
 the
 NIH‐R21AI079925, 
Thrasher
 Research 
Fund, 
NIH/NICATS 
Colorado 
CCTS 
grant 
Ul1
TR000154,
 Shell, 
Mandell,
 Boyd 
and 
Savoie 
Families, 
American 
Gastroenterological 
Association,
 Campaign
 Urging
 Research
 for 
Eosinophilic 
Diseases, 
Buckeye
 Foundation, 
Pappas 
Foundation,
 American
 Partnership
 for 
Eosinophic 
Disorders, 
Sandhill 
Scientific, 
Mayo
 Foundation 
and
 NIH
HL058732 
and 
the 
SCRR
K26
RR0109709 
and
 NIH‐
 1UL1RR025741.

More 
information 
about
 UIC.

Contact


312-996-1583
jgala@uic.edu