Intestinal and Gastric Permeability in Children With Eosinophilic Esophagitis and Reflux Esophagitis

Leung, Aldrich Jing-Tao; Persad, Sujata; Slae, Mordechai; Abdelradi, Amr; Kluthe, Cheryl; Shirton, Leanne; Danchuk, Ronda; Persad, Rabin; Meddings, Jon; Huynh, Hien Q.

doi:10.1097/mpg.0000000000000590

Cited by 14 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are in keeping with the conclusion of Leung et al , that an alteration in small intestinal permeability does not play a role in EoE (26). In contrast, the group of Katzka et al demonstrated an increased small intestinal permeability in patients with active EoE (12).…”

Section: Discussionsupporting

confidence: 93%

“…This raises the question whether the esophagus is the sole site of allergen uptake in EoE, or whether allergens also permeate through the small intestine and initiate or aggravate an inflammation in a distant organ—the esophagus. The current literature on duodenal involvement in EoE is contradictory, with indications for increased small intestinal permeability found in one study in adults but not in another study in children (12, 13). Either way, esophageal and/or small intestinal mucosal integrity may be of pathophysiological relevance, and restoration of the mucosal integrity may be essential to accomplish complete histological remission.…”

Section: Introductionmentioning

confidence: 86%

See 1 more Smart Citation

Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet

Warners

Vlieg‐Boerstra

Verheij

et al. 2017

American Journal of Gastroenterology

View full text Add to dashboard Cite

Objectives:The esophageal mucosal integrity is impaired in eosinophilic esophagitis (EoE) and it has been suggested that the duodenal permeability is increased. The absence of food allergens may restore the integrity. The aims of this study were to assess duodenal permeability in EoE and to evaluate the effect of an elemental diet on the esophageal and duodenal integrity.Methods:In this prospective study 17 adult EoE patients and 8 healthy controls (HC) were included. Esophageal biopsy specimens were sampled before and after 4 weeks of elemental diet to measure eosinophil counts and gene expression of tight junction and barrier integrity proteins. Esophageal and duodenal impedance were measured by electrical tissue impedance spectroscopy and Ussing chambers were used to measure transepithelial resistance (TER) and transepithelial molecule flux. Small intestinal permeability was measured using a test, measuring lactulose/mannitol (L/M) ratios.Results:In EoE patients, the esophageal but not the duodenal integrity was impaired, compared with HC. We observed no significant difference between L/M ratios of HC and EoE patients. After diet, eosinophil counts decreased significantly, which was paralleled by normalization of esophageal impedance and transepithelial molecule flux. The esophageal TER improved significantly, but did not reach values seen in HC. Esophageal expression of genes encoding for barrier integrity proteins filaggrin and desmoglein-1 was impaired at baseline and restored after diet.Conclusions:An elemental diet restores esophageal integrity, suggesting that it is at least partly secondary to allergen exposure. Duodenal integrity seems not to be affected in EoE, and possibly plays a minor role in its pathophysiology.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 86%

Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet

Warners

Vlieg‐Boerstra

Verheij

et al. 2017

American Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…Noninvasive measurements using orally administered sugar probes (lactulose, mannitol, and sucrose) were used to determine gastrointestinal permeability at diagnosis and after one year on the GFD [ 15 – 18 ]. Urine samples were also collected from healthy individuals with no gastrointestinal symptoms or family history of CD [ 19 ]. Neither patients nor controls were taking any medications known to alter permeability.…”

Section: Methodsmentioning

confidence: 99%

A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

Rajani

Huynh

Shirton

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

Self Cite

View full text Add to dashboard Cite

Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD). We hypothesized that SD would be associated with similar short term outcomes as ED. Method. Children, 3–17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC), at baseline and after one year on a GFD were compared to patients who had ED. Results. Enrolled SD (n = 40) and ED (n = 48) patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M) (0.049 versus 0.034; p = 0.07), fractional excretion of sucrose (%FES; 0.086 versus 0.092; p = 0.44), or fecal calprotectin (FC; 89.6 versus 51.4; p = 0.05). At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025; p = 0.55) and %FES (0.040 versus 0.047; p = 0.87) (p > 0.05). FC improved but remained higher in the SD group (37.1 versus 15.9; p = 0.04). Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD.

show abstract

“…Similarly, Johnson et al 24 reported that EE was resolved after GFD in half of the adult patients with CD and EoE (n = 6). Although some reports suggested that increased mucosal permeability secondary to CD may lead to atopy because of increased exposure to antigens and allergens and causes EoE, 8,10,11 Leung et al 25 reported that an alteration in gastric and intestinal permeability does not play a role in EoE pathogenesis. According to molecular mechanisms Eotaxin‐3, interleukin‐5 and interleukin‐13 are reported to be the key effector molecules in EoE pathogenesis 7 …”

Section: Discussionmentioning

confidence: 99%

Association of celiac disease with eosophageal eosinophilia and eosinophilic eosophagitis

Urgancı

Usta

Civelek

2021

Int J Clinical Practice

View full text Add to dashboard Cite

Background Aim of the study was to evaluate the association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia in children. Methods A total of 278 patients with celiac disease (mean age: 7.12 ± 4.64 years, M/F: 0.77) were involved in the study. The patients were evaluated retrospectively in terms of clinical, endoscopic and histopathological findings. The association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia was determined. Results According to Marsh classification system 6 (2.1%) of the patients were graded type 3A, 10 (3.5%) were type 3B, 262 (94.4%) were type 3C. The histopathological examination of oesophageal biopsy specimens of the patients revealed <15 eosinophils per high power field in only 4 (1.4%) patients. Two of these patients were positive for HLA DQ8, one was DQ2, and the other one was both DQ8 and DQ2. Tissue transglutaminase IgA level was above 300 U/mL in these patients. None of them had elevated serum total IgE levels, peripheral eosinophilia and history of atopic diseases. The gastrointestinal symptoms resolved and tissue transglutaminase IgA level of the patients were declined after 3 months of gluten‐free diet. Conclusion Although an association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia have been postulated in recent years, no exact relationship was established in this study. This is the first study reporting the performance of follow‐up GI endoscopy with biopsies revealing the resolution of oesophageal eosinophilia.

show abstract

Intestinal and Gastric Permeability in Children With Eosinophilic Esophagitis and Reflux Esophagitis

Abstract: Our data suggest that an alteration in gastric and intestinal permeability does not play a role in EoE or RE pathogenesis.

Cited by 14 publications

References 32 publications

Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet

Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet

A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

Association of celiac disease with eosophageal eosinophilia and eosinophilic eosophagitis

Contact Info

Product

Resources

About