Use of the Esophageal Sponge in Directing Food Reintroduction in Eosinophilic Esophagitis

Jeffrey A. Alexander; Karthik Ravi; Thomas C. Symrk; Tsung The Wu; Crystal J. Lavey; Debra Geno; Alyssa J. Johnson; Ryan J. Lennon; Margaret H. Collins; Evan S. Dellon; David A. Katzka

doi:10.1016/j.cgh.2022.05.029

Use of the Esophageal Sponge in Directing Food Reintroduction in Eosinophilic Esophagitis

Jeffrey A. Alexander, Karthik Ravi, Thomas C. Symrk, Tsung The Wu, Crystal J. Lavey, Debra Geno, Alyssa J. Johnson, Ryan J. Lennon, Margaret H. Collins, Evan S. Dellon, David A. Katzka

Research output: Contribution to journal › Article › peer-review

Abstract

Background & Aims: Dietary therapy is successful in eosinophilic esophagitis (EoE) but requires multiple upper endoscopies. The aim of this study was to determine if food reintroduction in EoE can be directed by minimally-invasive esophageal sponge cytology. Methods: In this prospective non-blinded trial, 22 responders to 6-food elimination diets underwent sequential food reintroduction guided by esophageal sponge cytology. Foods were reintroduced followed by unsedated esophageal sponge cytology assessment. A food trigger was defined by sponge cytology peak eosinophil count of ≥15 eos/high-powered field (hpf). Symptoms (EoE symptom activity index [EEsAI]), endoscopic score (EoE endoscopic reference score [EREFS]), and biopsy histology (peak eosinophil count) were collected pre-dietary therapy and post-dietary therapy, and then 4 weeks post food reintroduction. Results: The EEsAI and EREFS were similar post-dietary therapy to post-food reintroduction: 12.0 (interquartile range [IQR], 0.0–27.0) vs 16.5 (IQR, 9.0–28.8) (P = .265) and 1.5 (IQR, 0.2–3.0) vs 1.0 (IQR, 0.0–2.0) (P = .185). However, the peak eosinophil count was increased post-food reintroduction compared with post-dietary therapy: 20.0 (IQR, 5.0–51.5) vs 2.0 (IQR, 1.0–4.0) (P < .001), suggesting a failure of identification of all food triggers. The peak eosinophil count was lower post-food reintroduction compared with pre-dietary therapy: 20.0 (IQR, 5.0–51.5) vs 52.0 (IQR, 30.8–76.2) (P = .008). At the post food reintroduction evaluation, sponge cytology and biopsy histology were in agreement in 59% (13/22) of cases using a cutoff of <15 eos/hpf and 68% (15/22) of cases using a cutoff of <6 eos/hpf. Conclusions: In the first study to evaluate a non-endoscopic technique in the clinical management of EoE, the esophageal sponge was moderately successful at guiding food reintroduction in EoE dietary responders in the outpatient setting. Clinicaltrials.gov, Number NCT02599558.

Original language	English (US)
Pages (from-to)	299-306.e3
Journal	Clinical Gastroenterology and Hepatology
Volume	21
Issue number	2
DOIs	https://doi.org/10.1016/j.cgh.2022.05.029
State	Published - Feb 2023

Keywords

Eosinophilic Esophagitis
Esophageal Sponge Cytology
Food Reintroduction

ASJC Scopus subject areas

Hepatology
Gastroenterology

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10.1016/j.cgh.2022.05.029

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@article{2b2ea69d070c4002946350209a018eba,

title = "Use of the Esophageal Sponge in Directing Food Reintroduction in Eosinophilic Esophagitis",

abstract = "Background & Aims: Dietary therapy is successful in eosinophilic esophagitis (EoE) but requires multiple upper endoscopies. The aim of this study was to determine if food reintroduction in EoE can be directed by minimally-invasive esophageal sponge cytology. Methods: In this prospective non-blinded trial, 22 responders to 6-food elimination diets underwent sequential food reintroduction guided by esophageal sponge cytology. Foods were reintroduced followed by unsedated esophageal sponge cytology assessment. A food trigger was defined by sponge cytology peak eosinophil count of ≥15 eos/high-powered field (hpf). Symptoms (EoE symptom activity index [EEsAI]), endoscopic score (EoE endoscopic reference score [EREFS]), and biopsy histology (peak eosinophil count) were collected pre-dietary therapy and post-dietary therapy, and then 4 weeks post food reintroduction. Results: The EEsAI and EREFS were similar post-dietary therapy to post-food reintroduction: 12.0 (interquartile range [IQR], 0.0–27.0) vs 16.5 (IQR, 9.0–28.8) (P = .265) and 1.5 (IQR, 0.2–3.0) vs 1.0 (IQR, 0.0–2.0) (P = .185). However, the peak eosinophil count was increased post-food reintroduction compared with post-dietary therapy: 20.0 (IQR, 5.0–51.5) vs 2.0 (IQR, 1.0–4.0) (P < .001), suggesting a failure of identification of all food triggers. The peak eosinophil count was lower post-food reintroduction compared with pre-dietary therapy: 20.0 (IQR, 5.0–51.5) vs 52.0 (IQR, 30.8–76.2) (P = .008). At the post food reintroduction evaluation, sponge cytology and biopsy histology were in agreement in 59% (13/22) of cases using a cutoff of <15 eos/hpf and 68% (15/22) of cases using a cutoff of <6 eos/hpf. Conclusions: In the first study to evaluate a non-endoscopic technique in the clinical management of EoE, the esophageal sponge was moderately successful at guiding food reintroduction in EoE dietary responders in the outpatient setting. Clinicaltrials.gov, Number NCT02599558.",

keywords = "Eosinophilic Esophagitis, Esophageal Sponge Cytology, Food Reintroduction",

author = "Alexander, {Jeffrey A.} and Karthik Ravi and Symrk, {Thomas C.} and Wu, {Tsung The} and Lavey, {Crystal J.} and Debra Geno and Johnson, {Alyssa J.} and Lennon, {Ryan J.} and Collins, {Margaret H.} and Dellon, {Evan S.} and Katzka, {David A.}",

note = "Funding Information: Funding This study was funded with grant support from Aleta and Michael Belletete . Funding Information: Funding This study was funded with grant support from Aleta and Michael Belletete. Conflicts of interest These authors disclose the following: Jeffrey Alexander reports financial interest in Meritage Pharmacia; consulting agreement with Lucid Diagnostics; and research assistance with Regeneron, Ellodi, Arena, and Cellgene Pharmaceuticals. Evan Dellon reports research funding from Adare/Ellodi, Allakos, Arena, AstraZeneca, GSK, Meritage, Miraca, Nutricia, Celgene/Receptos/BMS, Regeneron, and Shire/Takeda; consultant for Abbott, Abbvie, Adare/ Ellodi, Aimmune, Allakos, Akesobio, Amgen, Arena, AstraZeneca, Avir, Biorasi, Calypso, Celgene/Receptos/BMS, Celldex, Eli Lilly, EsoCap, GSK, Gossamer Bio, InveniAI, Landos, LucidDx, Morphic, Nutricia, Parexel/Calyx, Phathom, Regeneron, Revolo, Robarts/Alimentiv, Salix, Sanofi, Shire/Takeda, and Target RWE; and educational grant from Allakos, Banner, and Holoclara. David A. Katzka reports research funding from Shire/Takeda. Consulting: Regeneron, and Takeda. Margaret H. Collins reports research funding from AstraZeneca, Meritage Pharma Inc., Receptos/Celgene/BMS, Regeneron Pharmaceuticals, and Shire, a Takeda Company; and is a consultant for Allakos, Arena Pharmaceuticals, AstraZeneca, Calypso Biotech, EsoCap Biotech, GlaxoSmithKline, Receptos/Celgene/BMS, Regeneron Pharmaceuticals, Robarts Clinical Trials Inc/Alimentiv, Inc, and Shire, a Takeda Company. The remaining authors disclose no conflicts. Publisher Copyright: {\textcopyright} 2023 AGA Institute",

year = "2023",

month = feb,

doi = "10.1016/j.cgh.2022.05.029",

language = "English (US)",

volume = "21",

pages = "299--306.e3",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders Ltd",

number = "2",

}

TY - JOUR

T1 - Use of the Esophageal Sponge in Directing Food Reintroduction in Eosinophilic Esophagitis

AU - Alexander, Jeffrey A.

AU - Ravi, Karthik

AU - Symrk, Thomas C.

AU - Wu, Tsung The

AU - Lavey, Crystal J.

AU - Geno, Debra

AU - Johnson, Alyssa J.

AU - Lennon, Ryan J.

AU - Collins, Margaret H.

AU - Dellon, Evan S.

AU - Katzka, David A.

N1 - Funding Information: Funding This study was funded with grant support from Aleta and Michael Belletete . Funding Information: Funding This study was funded with grant support from Aleta and Michael Belletete. Conflicts of interest These authors disclose the following: Jeffrey Alexander reports financial interest in Meritage Pharmacia; consulting agreement with Lucid Diagnostics; and research assistance with Regeneron, Ellodi, Arena, and Cellgene Pharmaceuticals. Evan Dellon reports research funding from Adare/Ellodi, Allakos, Arena, AstraZeneca, GSK, Meritage, Miraca, Nutricia, Celgene/Receptos/BMS, Regeneron, and Shire/Takeda; consultant for Abbott, Abbvie, Adare/ Ellodi, Aimmune, Allakos, Akesobio, Amgen, Arena, AstraZeneca, Avir, Biorasi, Calypso, Celgene/Receptos/BMS, Celldex, Eli Lilly, EsoCap, GSK, Gossamer Bio, InveniAI, Landos, LucidDx, Morphic, Nutricia, Parexel/Calyx, Phathom, Regeneron, Revolo, Robarts/Alimentiv, Salix, Sanofi, Shire/Takeda, and Target RWE; and educational grant from Allakos, Banner, and Holoclara. David A. Katzka reports research funding from Shire/Takeda. Consulting: Regeneron, and Takeda. Margaret H. Collins reports research funding from AstraZeneca, Meritage Pharma Inc., Receptos/Celgene/BMS, Regeneron Pharmaceuticals, and Shire, a Takeda Company; and is a consultant for Allakos, Arena Pharmaceuticals, AstraZeneca, Calypso Biotech, EsoCap Biotech, GlaxoSmithKline, Receptos/Celgene/BMS, Regeneron Pharmaceuticals, Robarts Clinical Trials Inc/Alimentiv, Inc, and Shire, a Takeda Company. The remaining authors disclose no conflicts. Publisher Copyright: © 2023 AGA Institute

PY - 2023/2

Y1 - 2023/2

N2 - Background & Aims: Dietary therapy is successful in eosinophilic esophagitis (EoE) but requires multiple upper endoscopies. The aim of this study was to determine if food reintroduction in EoE can be directed by minimally-invasive esophageal sponge cytology. Methods: In this prospective non-blinded trial, 22 responders to 6-food elimination diets underwent sequential food reintroduction guided by esophageal sponge cytology. Foods were reintroduced followed by unsedated esophageal sponge cytology assessment. A food trigger was defined by sponge cytology peak eosinophil count of ≥15 eos/high-powered field (hpf). Symptoms (EoE symptom activity index [EEsAI]), endoscopic score (EoE endoscopic reference score [EREFS]), and biopsy histology (peak eosinophil count) were collected pre-dietary therapy and post-dietary therapy, and then 4 weeks post food reintroduction. Results: The EEsAI and EREFS were similar post-dietary therapy to post-food reintroduction: 12.0 (interquartile range [IQR], 0.0–27.0) vs 16.5 (IQR, 9.0–28.8) (P = .265) and 1.5 (IQR, 0.2–3.0) vs 1.0 (IQR, 0.0–2.0) (P = .185). However, the peak eosinophil count was increased post-food reintroduction compared with post-dietary therapy: 20.0 (IQR, 5.0–51.5) vs 2.0 (IQR, 1.0–4.0) (P < .001), suggesting a failure of identification of all food triggers. The peak eosinophil count was lower post-food reintroduction compared with pre-dietary therapy: 20.0 (IQR, 5.0–51.5) vs 52.0 (IQR, 30.8–76.2) (P = .008). At the post food reintroduction evaluation, sponge cytology and biopsy histology were in agreement in 59% (13/22) of cases using a cutoff of <15 eos/hpf and 68% (15/22) of cases using a cutoff of <6 eos/hpf. Conclusions: In the first study to evaluate a non-endoscopic technique in the clinical management of EoE, the esophageal sponge was moderately successful at guiding food reintroduction in EoE dietary responders in the outpatient setting. Clinicaltrials.gov, Number NCT02599558.

AB - Background & Aims: Dietary therapy is successful in eosinophilic esophagitis (EoE) but requires multiple upper endoscopies. The aim of this study was to determine if food reintroduction in EoE can be directed by minimally-invasive esophageal sponge cytology. Methods: In this prospective non-blinded trial, 22 responders to 6-food elimination diets underwent sequential food reintroduction guided by esophageal sponge cytology. Foods were reintroduced followed by unsedated esophageal sponge cytology assessment. A food trigger was defined by sponge cytology peak eosinophil count of ≥15 eos/high-powered field (hpf). Symptoms (EoE symptom activity index [EEsAI]), endoscopic score (EoE endoscopic reference score [EREFS]), and biopsy histology (peak eosinophil count) were collected pre-dietary therapy and post-dietary therapy, and then 4 weeks post food reintroduction. Results: The EEsAI and EREFS were similar post-dietary therapy to post-food reintroduction: 12.0 (interquartile range [IQR], 0.0–27.0) vs 16.5 (IQR, 9.0–28.8) (P = .265) and 1.5 (IQR, 0.2–3.0) vs 1.0 (IQR, 0.0–2.0) (P = .185). However, the peak eosinophil count was increased post-food reintroduction compared with post-dietary therapy: 20.0 (IQR, 5.0–51.5) vs 2.0 (IQR, 1.0–4.0) (P < .001), suggesting a failure of identification of all food triggers. The peak eosinophil count was lower post-food reintroduction compared with pre-dietary therapy: 20.0 (IQR, 5.0–51.5) vs 52.0 (IQR, 30.8–76.2) (P = .008). At the post food reintroduction evaluation, sponge cytology and biopsy histology were in agreement in 59% (13/22) of cases using a cutoff of <15 eos/hpf and 68% (15/22) of cases using a cutoff of <6 eos/hpf. Conclusions: In the first study to evaluate a non-endoscopic technique in the clinical management of EoE, the esophageal sponge was moderately successful at guiding food reintroduction in EoE dietary responders in the outpatient setting. Clinicaltrials.gov, Number NCT02599558.

KW - Eosinophilic Esophagitis

KW - Esophageal Sponge Cytology

KW - Food Reintroduction

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U2 - 10.1016/j.cgh.2022.05.029

DO - 10.1016/j.cgh.2022.05.029

M3 - Article

C2 - 35697266

AN - SCOPUS:85136305260

SN - 1542-3565

VL - 21

SP - 299-306.e3

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 2

ER -

Use of the Esophageal Sponge in Directing Food Reintroduction in Eosinophilic Esophagitis

Abstract

Keywords

ASJC Scopus subject areas

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