One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis

Steven J. Ackerman, Amir F. Kagalwalla, Ikuo Hirano, Nirmala Gonsalves, Paul Menard Katcher, Sandeep Gupta, Joshua B. Wechsler, Milica Grozdanovic, Zhaoxing Pan, Joanne C. Masterson, Jian Du, Robert J. Fantus, Preeth Alumkal, James J. Lee, Sergei Ochkur, Faria Ahmed, Kelley Capocelli, Hector Melin-Aldana, Kathryn Biette, Allison DubnerKatie Amsden, Kaitlin Keeley, Maureen Sulkowski, Angelika Zalewski, Dan Atkins, Glenn T. Furuta

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVES: Eosinophilic esophagitis (EoE), a chronic food allergic disease, lacks sensitive and specific peripheral biomarkers. We hypothesized that levels of EoE-related biomarkers captured using a 1-hour minimally invasive Esophageal String Test (EST) would correlate with mucosal eosinophil counts and tissue concentrations of these same biomarkers. We aimed to determine whether a 1-hour EST accurately distinguishes active from inactive EoE or a normal esophagus. METHODS: In a prospective, multisite study, children and adults (ages 7-55 years) undergoing a clinically indicated esophagogastroduodenoscopy performed an EST with an esophageal dwell time of 1 hour. Subjects were divided into 3 groups: active EoE, inactive EoE, and normal esophageal mucosa. Eosinophil-associated protein levels were compared between EST effluents and esophageal biopsy extracts. Statistical modeling was performed to select biomarkers that best correlated with and predicted eosinophilic inflammation. RESULTS: One hundred thirty-four subjects (74 children, 60 adults) with active EoE (n = 62), inactive EoE (n = 37), and patient controls with a normal esophagus (n = 35) completed the study. EST-captured eosinophil-associated biomarkers correlated significantly with peak eosinophils/high-power field, endoscopic visual scoring, and the same proteins extracted from mucosal biopsies. Statistical modeling, using combined eotaxin-3 and major basic protein-1 concentrations, led to the development of EoE scores that distinguished subjects with active EoE from inactive EoE or normal esophagi. Eighty-seven percent of children, 95% of parents, and 92% of adults preferred the EST over endoscopy if it provided similar information. DISCUSSION: The 1-hour EST accurately distinguishes active from inactive EoE in children and adults and may facilitate monitoring of disease activity in a safe and minimally invasive fashion.

Original languageEnglish (US)
Pages (from-to)1614-1625
Number of pages12
JournalThe American journal of gastroenterology
Volume114
Issue number10
DOIs
StatePublished - Oct 1 2019

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Eosinophilic Esophagitis
Eosinophils
Biomarkers
Esophagus
Digestive System Endoscopy
Biopsy
Proteins
Visual Fields
Endoscopy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Ackerman, Steven J. ; Kagalwalla, Amir F. ; Hirano, Ikuo ; Gonsalves, Nirmala ; Katcher, Paul Menard ; Gupta, Sandeep ; Wechsler, Joshua B. ; Grozdanovic, Milica ; Pan, Zhaoxing ; Masterson, Joanne C. ; Du, Jian ; Fantus, Robert J. ; Alumkal, Preeth ; Lee, James J. ; Ochkur, Sergei ; Ahmed, Faria ; Capocelli, Kelley ; Melin-Aldana, Hector ; Biette, Kathryn ; Dubner, Allison ; Amsden, Katie ; Keeley, Kaitlin ; Sulkowski, Maureen ; Zalewski, Angelika ; Atkins, Dan ; Furuta, Glenn T. / One-Hour Esophageal String Test : A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis. In: The American journal of gastroenterology. 2019 ; Vol. 114, No. 10. pp. 1614-1625.
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abstract = "OBJECTIVES: Eosinophilic esophagitis (EoE), a chronic food allergic disease, lacks sensitive and specific peripheral biomarkers. We hypothesized that levels of EoE-related biomarkers captured using a 1-hour minimally invasive Esophageal String Test (EST) would correlate with mucosal eosinophil counts and tissue concentrations of these same biomarkers. We aimed to determine whether a 1-hour EST accurately distinguishes active from inactive EoE or a normal esophagus. METHODS: In a prospective, multisite study, children and adults (ages 7-55 years) undergoing a clinically indicated esophagogastroduodenoscopy performed an EST with an esophageal dwell time of 1 hour. Subjects were divided into 3 groups: active EoE, inactive EoE, and normal esophageal mucosa. Eosinophil-associated protein levels were compared between EST effluents and esophageal biopsy extracts. Statistical modeling was performed to select biomarkers that best correlated with and predicted eosinophilic inflammation. RESULTS: One hundred thirty-four subjects (74 children, 60 adults) with active EoE (n = 62), inactive EoE (n = 37), and patient controls with a normal esophagus (n = 35) completed the study. EST-captured eosinophil-associated biomarkers correlated significantly with peak eosinophils/high-power field, endoscopic visual scoring, and the same proteins extracted from mucosal biopsies. Statistical modeling, using combined eotaxin-3 and major basic protein-1 concentrations, led to the development of EoE scores that distinguished subjects with active EoE from inactive EoE or normal esophagi. Eighty-seven percent of children, 95{\%} of parents, and 92{\%} of adults preferred the EST over endoscopy if it provided similar information. DISCUSSION: The 1-hour EST accurately distinguishes active from inactive EoE in children and adults and may facilitate monitoring of disease activity in a safe and minimally invasive fashion.",
author = "Ackerman, {Steven J.} and Kagalwalla, {Amir F.} and Ikuo Hirano and Nirmala Gonsalves and Katcher, {Paul Menard} and Sandeep Gupta and Wechsler, {Joshua B.} and Milica Grozdanovic and Zhaoxing Pan and Masterson, {Joanne C.} and Jian Du and Fantus, {Robert J.} and Preeth Alumkal and Lee, {James J.} and Sergei Ochkur and Faria Ahmed and Kelley Capocelli and Hector Melin-Aldana and Kathryn Biette and Allison Dubner and Katie Amsden and Kaitlin Keeley and Maureen Sulkowski and Angelika Zalewski and Dan Atkins and Furuta, {Glenn T.}",
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Ackerman, SJ, Kagalwalla, AF, Hirano, I, Gonsalves, N, Katcher, PM, Gupta, S, Wechsler, JB, Grozdanovic, M, Pan, Z, Masterson, JC, Du, J, Fantus, RJ, Alumkal, P, Lee, JJ, Ochkur, S, Ahmed, F, Capocelli, K, Melin-Aldana, H, Biette, K, Dubner, A, Amsden, K, Keeley, K, Sulkowski, M, Zalewski, A, Atkins, D & Furuta, GT 2019, 'One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis', The American journal of gastroenterology, vol. 114, no. 10, pp. 1614-1625. https://doi.org/10.14309/ajg.0000000000000371

One-Hour Esophageal String Test : A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis. / Ackerman, Steven J.; Kagalwalla, Amir F.; Hirano, Ikuo; Gonsalves, Nirmala; Katcher, Paul Menard; Gupta, Sandeep; Wechsler, Joshua B.; Grozdanovic, Milica; Pan, Zhaoxing; Masterson, Joanne C.; Du, Jian; Fantus, Robert J.; Alumkal, Preeth; Lee, James J.; Ochkur, Sergei; Ahmed, Faria; Capocelli, Kelley; Melin-Aldana, Hector; Biette, Kathryn; Dubner, Allison; Amsden, Katie; Keeley, Kaitlin; Sulkowski, Maureen; Zalewski, Angelika; Atkins, Dan; Furuta, Glenn T.

In: The American journal of gastroenterology, Vol. 114, No. 10, 01.10.2019, p. 1614-1625.

Research output: Contribution to journalArticle

TY - JOUR

T1 - One-Hour Esophageal String Test

T2 - A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis

AU - Ackerman, Steven J.

AU - Kagalwalla, Amir F.

AU - Hirano, Ikuo

AU - Gonsalves, Nirmala

AU - Katcher, Paul Menard

AU - Gupta, Sandeep

AU - Wechsler, Joshua B.

AU - Grozdanovic, Milica

AU - Pan, Zhaoxing

AU - Masterson, Joanne C.

AU - Du, Jian

AU - Fantus, Robert J.

AU - Alumkal, Preeth

AU - Lee, James J.

AU - Ochkur, Sergei

AU - Ahmed, Faria

AU - Capocelli, Kelley

AU - Melin-Aldana, Hector

AU - Biette, Kathryn

AU - Dubner, Allison

AU - Amsden, Katie

AU - Keeley, Kaitlin

AU - Sulkowski, Maureen

AU - Zalewski, Angelika

AU - Atkins, Dan

AU - Furuta, Glenn T.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - OBJECTIVES: Eosinophilic esophagitis (EoE), a chronic food allergic disease, lacks sensitive and specific peripheral biomarkers. We hypothesized that levels of EoE-related biomarkers captured using a 1-hour minimally invasive Esophageal String Test (EST) would correlate with mucosal eosinophil counts and tissue concentrations of these same biomarkers. We aimed to determine whether a 1-hour EST accurately distinguishes active from inactive EoE or a normal esophagus. METHODS: In a prospective, multisite study, children and adults (ages 7-55 years) undergoing a clinically indicated esophagogastroduodenoscopy performed an EST with an esophageal dwell time of 1 hour. Subjects were divided into 3 groups: active EoE, inactive EoE, and normal esophageal mucosa. Eosinophil-associated protein levels were compared between EST effluents and esophageal biopsy extracts. Statistical modeling was performed to select biomarkers that best correlated with and predicted eosinophilic inflammation. RESULTS: One hundred thirty-four subjects (74 children, 60 adults) with active EoE (n = 62), inactive EoE (n = 37), and patient controls with a normal esophagus (n = 35) completed the study. EST-captured eosinophil-associated biomarkers correlated significantly with peak eosinophils/high-power field, endoscopic visual scoring, and the same proteins extracted from mucosal biopsies. Statistical modeling, using combined eotaxin-3 and major basic protein-1 concentrations, led to the development of EoE scores that distinguished subjects with active EoE from inactive EoE or normal esophagi. Eighty-seven percent of children, 95% of parents, and 92% of adults preferred the EST over endoscopy if it provided similar information. DISCUSSION: The 1-hour EST accurately distinguishes active from inactive EoE in children and adults and may facilitate monitoring of disease activity in a safe and minimally invasive fashion.

AB - OBJECTIVES: Eosinophilic esophagitis (EoE), a chronic food allergic disease, lacks sensitive and specific peripheral biomarkers. We hypothesized that levels of EoE-related biomarkers captured using a 1-hour minimally invasive Esophageal String Test (EST) would correlate with mucosal eosinophil counts and tissue concentrations of these same biomarkers. We aimed to determine whether a 1-hour EST accurately distinguishes active from inactive EoE or a normal esophagus. METHODS: In a prospective, multisite study, children and adults (ages 7-55 years) undergoing a clinically indicated esophagogastroduodenoscopy performed an EST with an esophageal dwell time of 1 hour. Subjects were divided into 3 groups: active EoE, inactive EoE, and normal esophageal mucosa. Eosinophil-associated protein levels were compared between EST effluents and esophageal biopsy extracts. Statistical modeling was performed to select biomarkers that best correlated with and predicted eosinophilic inflammation. RESULTS: One hundred thirty-four subjects (74 children, 60 adults) with active EoE (n = 62), inactive EoE (n = 37), and patient controls with a normal esophagus (n = 35) completed the study. EST-captured eosinophil-associated biomarkers correlated significantly with peak eosinophils/high-power field, endoscopic visual scoring, and the same proteins extracted from mucosal biopsies. Statistical modeling, using combined eotaxin-3 and major basic protein-1 concentrations, led to the development of EoE scores that distinguished subjects with active EoE from inactive EoE or normal esophagi. Eighty-seven percent of children, 95% of parents, and 92% of adults preferred the EST over endoscopy if it provided similar information. DISCUSSION: The 1-hour EST accurately distinguishes active from inactive EoE in children and adults and may facilitate monitoring of disease activity in a safe and minimally invasive fashion.

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