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

Abstract

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.

A Conceptual Approach to Understanding Treatment Response in Eosinophilic Esophagitis

“…[112][113][114][115][116] Noninvasive markers have also been assessed in the blood, stool, and urine, though in general results have not been strong enough to be applied clinically. [117][118][119][120][121][122] Esophageal gene expression has also been assessed. The EoE Diagnostic Panel consists of a 94-gene signature that is strongly associated with a diagnosis of EoE, 123 can be assessed on a single biopsy, 124 and is responsive to successful treatment.…”

A visual analogue scale and a Likert scale are simple and responsive tools for assessing dysphagia in eosinophilic oesophagitis

“…This point remains particularly salient given the increased cost and inconsistent results of more invasive measures to assess EoE disease activity. 40,41 …”

Prevalence and Incidence of Intestinal Metaplasia and Dysplasia of Gastric Cardia in Patients With Barrett’s Esophagus After Endoscopic Therapy

“…using high-definition white light and narrow-band imaging with careful inspection of the cardia and esophagus. In addition to clinical biopsies, 13 standardized biopsies were obtained per research protocol for this study from 4 quadrants in 4 locations for a total of 16 biopsies. The locations included (1) the distal esophagus, 1 cm proximal to top of gastric folds (TGF-1); (2) at top of gastric folds (TGF); (3) 1 cm into the gastric cardia (TGFþ1); and (4) 2 cm into the cardia (TGFþ2), ( Supplementary Figure 1).…”