Esophageal remodeling in pediatric eosinophilic esophagitis.
BACKGROUND
Eosinophils are associated with airway remodeling in asthma, but studies have not yet determined whether eosinophilic esophagitis (EE) is associated with esophageal remodeling.


OBJECTIVE
We performed quantitative immunohistochemical analysis of remodeling changes in esophageal biopsy specimens from children with and without EE to evaluate if there were changes in the esophagus of pediatric patients with EE akin to airway remodeling. In addition, we determined whether the esophagus of patients with EE had increased levels of expression of TGF-beta(1) and its signaling molecule, phosphorylated SMAD2/3 (phospho-SMAD2/3).


METHODS
To determine esophageal levels of eosinophilic inflammation, fibrosis, and vascular activation, endoscopically obtained esophageal biopsy specimens from 7 patients with EE (5 strictured, 2 nonstrictured), 7 with gastroesophageal reflux disease, and 7 normal patients were processed for immunohistology, trichrome staining, and assessment of levels of expression of TGF-beta(1), phospho-SMAD2/3, and vascular cell adhesion molecule 1.


RESULTS
Esophageal biopsies in patients with EE demonstrated increased levels of subepithelial fibrosis and increased expression of TGF-beta(1) and its signaling molecule phospho-SMAD2/3 compared with gastroesophageal reflux disease and normal control patients. In addition, esophageal biopsies in patients with EE demonstrated an increased vascular density and an increased expression of the vascular endothelial adhesion molecule, vascular cell adhesion molecule 1.


CONCLUSIONS
Previously unrecognized esophageal remodeling changes analogous to aspects of airway remodeling are detectable in the subepithelial region of the esophagus in pediatric patients with EE.


CONCLUSIONS
Pediatric patients with EE demonstrate increased fibrosis, vascularity, and vascular activation in the esophagus that may contribute to stricture formation and potentially provide a basis for stratifying patients with EE on the basis of disease severity and/or prognosis.
Aceves
Seema S
SS
Division of Allergy, Immunology, Children's Hospital, San Diego, and the University of California, San Diego, CA 92123, USA. saceves@chsd.org
Newbury
Robert O
RO
Dohil
Ranjan
R
Bastian
John F
JF
Broide
David H
DH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004802:Eosinophilia / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D004941:Esophagitis / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D004947:Esophagus / Q000098:blood supply / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000150:complications / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D051896:Smad Proteins, Receptor-Regulated / Q000378:metabolism; D053773:Transforming Growth Factor beta1 / Q000378:metabolism
D051896:Smad Proteins, Receptor-Regulated; D053773:Transforming Growth Factor beta1