Assessment of fractionated exhaled nitric oxide as a biomarker for the treatment of eosinophilic esophagitis

Leung, John; Nguyen-Traxler, Ann; Lee, Erika M.; Yip, Jason S.; Weinstock, Joel V.; Chan, Walter W.; Ngo, Peter; Weinstein, Barbara; Bonis, Peter A

doi:10.2500/aap.2012.33.3606

Cited by 25 publications

(23 citation statements)

References 29 publications

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“…Recently, fractionated exhaled nitric oxide has been measured in EoO patients. Although levels differed slightly before and after treatment with topical steroids, they did not correlate with clinical or histological response . Changes in exhaled nitric oxide may reflect inflammation in the airway rather than the oesophagus.…”

Section: Eosinophilic Oesophagitis: Diagnosis and Definitionmentioning

confidence: 72%

Recent advances in the pathophysiology and management of eosinophilic oesophagitis

Epstein

Warner²

2014

Clin Experimental Allergy

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Eosinophilic oesophagitis is an increasingly recognized allergic gastrointestinal disease, which is becoming more common. Although the average age at diagnosis is 30-50 years, it often affects very young children and carries significant long-term morbidity. While our understanding of its pathophysiology is accumulating, the precise pathways by which the disease arises remain unclear. There are inconsistencies in its diagnosis and definition, and a drive towards international standardization is underway. Current methods for diagnosis and monitoring are relatively invasive, and controversies surround their interpretation. Management strategies are imperfect and involve burdensome long-term dietary exclusions, or drug treatments with uncertain efficacy or serious side-effects. It is the focus of a rapidly increasing body of research, the latest insights from which are systematically presented in this review.

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Section: Eosinophilic Oesophagitis: Diagnosis and Definitionmentioning

confidence: 72%

Recent advances in the pathophysiology and management of eosinophilic oesophagitis

Epstein

Warner²

2014

Clin Experimental Allergy

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“…[4][5][6] As a result of this burden of diagnosis and monitoring, 7 non-invasive biomarkers would have a valuable role. While there is intense research in biomarker discovery in EoE, to date results regarding serum, [8][9][10][11][12][13][14][15] saliva, 16 stool, 8,9 and respiratory 17,18 biomarkers have been mixed and none are routinely used in clinical care. 19 Periostin is an extracellular matrix protein that is present in the oesophageal epithelium, is highly expressed in patients with EoE, and is induced by IL-13.…”

Section: Discussionmentioning

confidence: 99%

“…At baseline, the EoE cases had a slightly higher median baseline serum periostin level than controls [22.1 ng/mL (IQR 20-26) vs. 20.7 (16)(17)(18)(19)(20)(21)(22)(23)(24); P = 0.04] ( Table 1). However, the AUC was just 0.60 for using this marker for diagnosis of EoE.…”

Section: Baseline and Post-treatment Periostin Levelsmentioning

confidence: 99%

Prospective assessment of serum periostin as a biomarker for diagnosis and monitoring of eosinophilic oesophagitis

Dellon

Higgins

Beitia

et al. 2016

Aliment Pharmacol Ther

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Summary Background Periostin is highly expressed in eosinophilic esophagitis (EoE), but has not been extensively studied as a non-invasive biomarker. Aim To assess whether serum periostin distinguished EoE from controls at baseline, had utility for monitoring treatment response, or was associated with IL-13 levels. Methods This was a sub-analysis of a prospective cohort study of adults undergoing outpatient upper endoscopy. Incident cases of EoE were diagnosed per consensus guidelines. Controls were subjects with either GERD or dysphagia without EoE. EoE patients were treated with swallowed/topical steroids and had repeat endoscopy/biopsy. Serum periostin levels for cases and controls were compared at baseline, and pre/post-treatment levels were compared for cases. Serum IL-13 and tissue expression of periostin were also assessed. Results A total of 61 incident EoE cases and 87 controls were analyzed. Despite a marked increase in tissue periostin expression in cases, the median baseline serum periostin level was only slightly higher in cases than controls (22.1 ng/mL vs 20.7; p=0.04); there was no change in post-treatment levels. There was also no difference in serum periostin for cases by histologic response or atopic status. There was a strong trend towards higher serum IL-13 levels in cases in the highest periostin quartile (57.1 pg/mL vs 2.6; p=0.07). Conclusions Serum periostin levels were similar in cases and controls, and there were no changes post-treatment. Given elevated IL-13 levels in the EoE patients with the highest periostin levels, future studies could explore periostin as a biomarker in EoE, perhaps in the setting of anti-IL-13 therapy.

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“…Since EoE is characterized by eosinophilia and basic studies suggest a link to pulmonary eosinophilia FeNO was measured in a prospectively study of 11 non-asthmatic subjects with active esophagitis before and after treatment[39]. Five patients responded histologically to topical steroids; while patients experienced a decline in FeNO, this difference did not reach statistical significance.…”

Section: Introductionmentioning

confidence: 99%

Non- and Semi-Invasive Methods of Monitoring Eosinophilic Esophagitis

Menard‐Katcher

Furuta²

2014

Dig Dis

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Background/Aims: Monitoring inflammation associated with eosinophilic esophagitis (EoE) relies on the identification of biomarkers that provide an objective measure of disease activity. To date, this metric has been the number of eosinophils in the squamous epithelial tissue. The search for alternative biomarkers as well as alternative methods to capture them has been the topic of much research. Methods: Based on clinicalexperience and a review of the literature, the aim of this chapter is to identify potential EoE biomarkers and methods to assess them. Results: With respect to the biomarkers, a number of candidates have arisen, including peripheral blood eosinophils, eosinophil granule proteins, Th2-related cytokines and exhaled nitric oxide. Methods to assess these biomarkers have included peripheral blood, luminal lavages and breath collections. Conclusions: Future research will identify the best clinical outcome measure for EoE. While mucosal eosinophilia currently serves as a well-defined metric of inflammation, newer research studies will continue to address whether this number correlates reliably with other patient-reported outcomes, endoscopic findings, molecular analyses or other yet to be defined biomarkers.

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Assessment of fractionated exhaled nitric oxide as a biomarker for the treatment of eosinophilic esophagitis

Abstract: Diagnosis of eosinophilic esophagitis (EoE)

Cited by 25 publications

References 29 publications

Recent advances in the pathophysiology and management of eosinophilic oesophagitis

Recent advances in the pathophysiology and management of eosinophilic oesophagitis

Prospective assessment of serum periostin as a biomarker for diagnosis and monitoring of eosinophilic oesophagitis

Non- and Semi-Invasive Methods of Monitoring Eosinophilic Esophagitis

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