An Increasing Trend of Eosinophilic Esophagitis in Korea and the Clinical Implication of the Biomarkers to Determine Disease Activity and Treatment Response in Eosinophilic Esophagitis
- Author:
Ga Hee KIM
1
;
Young Soo PARK
;
Kee Wook JUNG
;
Mimi KIM
;
Hee Kyong NA
;
Ji Yong AHN
;
Jeong Hoon LEE
;
Do Hoon KIM
;
Kee Don CHOI
;
Ho June SONG
;
Gin Hyug LEE
;
Evan S DELLON
;
Hwoon Yong JUNG
Author Information
- Publication Type:Original Article
- Keywords: Endoscopy; Eosinophilic esophagitis; Esophagus
- MeSH: Asian Continental Ancestry Group; Biomarkers; Biopsy; Deglutition Disorders; Diagnosis; Endoscopy; Eosinophilic Esophagitis; Eosinophils; Epidemiology; Esophagus; Female; Heartburn; Humans; Incidence; Korea; Male; Retrospective Studies; Tryptases
- From:Journal of Neurogastroenterology and Motility 2019;25(4):525-533
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: The epidemiology and pathogenesis of eosinophilic esophagitis (EoE) remain unclear in Asian countries. We investigated clinicopathological characteristics and diagnostic trends of EoE, and evaluated 3 tissue biomarkers for correlation with disease activity and treatment response in Korean patients with EoE. METHODS: We retrospectively reviewed 25 271 esophageal biopsies performed during upper endoscopies between 2006 and 2017. We diagnosed EoE based on ≥ 15 eosinophils/high-power field (HPF) and, symptoms of esophageal dysfunction. We performed immunohistochemical analysis for tryptase, eosinophilic derived neurotoxin (EDN), and eotaxin-3. RESULTS: We diagnosed EoE in 72 patients (53 men and 19 women; mean age, 46.2 years) with presenting symptoms of, dysphagia (15.3%), epigastric pain (31.9%), and heartburn (30.6%). The diagnostic rate of EoE considerably increased between 2006 and 2017, from 0.29 diagnoses to 7.99 diagnoses per 1000 esophageal biopsies (P < 0.001). The mean peak eosinophil count (PEC) was 56.0 (± 77.8)/HPF. Whereas the EDN (rho = 0.667, P < 0.001) and eotaxin-3 levels (rho = 0.465, P < 0.001) correlated with PEC, tryptase and PEC were weakly correlated (rho = 0.291, P = 0.013). EDN (rho = 0.279, P = 0.017), and tryptase (rho = 0.279, P = 0.033) correlated with the inflammatory score of Eosinophilic Esophagitis Endoscopic Reference Score. Immunohistochemical analysis and changes in tryptase, EDN, and eotaxin-3 levels were associated with histologic and endoscopic improvements. CONCLUSIONS: EoE incidence considerably increased during the 12-year period, regardless of endoscopic esophageal biopsy rate. Tryptase, EDN, and eotaxin-3 levels in esophageal biopsy specimens could be promising biomarkers for disease activity, symptom, and endoscopic response in Korea.
