Predictors of Treatment Response to Swallowed Steroids in Adults with EoE

Eosinophilic Esophagitis (EoE) is a chronic allergic immune disease that is increasing in prevalence. Left untreated, scar tissue can develop leading to narrowing of the esophagus. This leads to esophageal stricture which causes recurrent food impaction, a medical emergency. While removal of dietary antigens is effective for many patients, this treatment can fail or may not be feasible due to reasons such as cost and availability of alternatives. Treatment with swallowed corticosteroids, such as fluticasone, which coat the mucosal surface, is a well-accepted alternative, and effective in many patients. However, predictors/biomarkers of the response to treatment are unknown. In the proposal, we will assess the RNA transcriptome in mucosal biopsies using next generation RNA sequencing among adults with EoE prior to treatment to determine molecular predictors of treatment response. Success of this grant will not only yield potential biomarker(s) of the response to treatment with corticosteroids, necessitating validation, but also critical insight into genes and pathways involved in the response to corticosteroids.