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

Abstract

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.

The presence of serum anti‐SARS‐CoV‐2 IgA appears to protect primary health care workers from COVID‐19

“…The models are given a value for explanatory power or goodness of fit, R and a value for stability, Q [ 29 ]. The Variable Importance Parameter was used as previously described [ 30 ]. Wilcoxon matched‐pairs signed rank test was used to compare two groups, and one‐way ANOVA Kruskal‐Wallis nonparametric test with Dunn's post‐test to compare three groups, applying GraphPad Prism software 9.0.2 (GraphPad, San Diego, CA, USA).…”

Applications of Artificial Intelligence to Eosinophilic Esophagitis

“…Swallowed and retrievable strings and sponges capturing luminal eosinophil-derived proteins, as well as absolute eosinophil count and eosinophil progenitor cells in peripheral blood samples, show promise, but sensitivity and specificity to EoE diagnoses are still inferior to EREFS scores [39][40][41][42]. While current biomarkers on their own lack accuracy, panels of blood tests and reported symptoms have been combined with multivariate analysis to accurately separate small groups of treatment responders from non-responders [43].…”

Validation of the Swedish Watson Dysphagia Scale for adult patients with eosinophilic esophagitis

“… 6–8 Moreover, items from the S-WDS were essential to provide stability in a multivariate model capable of separating histologic responders to treatment from nonresponders in patients with EoE who were treated with topical corticosteroids for 2 months. 9 The S-WDS is user-friendly, takes a short time to fill out, is easy to use in the clinic, and is focused on the main symptom of EoE, dysphagia, which is why a validation of this established instrument for assessment of EoE is warranted.…”