title: Correlation of ALOX15 expression with eosinophilic or reflux esophagitis in a cohort of pediatric patients with esophageal eosinophilia.
abstract: The differential diagnosis between eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) is often challenging. We recently showed that the ALOX15 protein is expressed in 95% of esophageal biopsies from patients with a definitive diagnosis of EoE. Here we correlated ALOX15 expression with the clinical classification of EoE or GERD in a cohort of consecutive pediatric patients (n = 62) with at least 1 esophageal biopsy containing at least 15 eosinophils per high-power field (eos/HPF). The patients were categorized into the following groups: (1) at least 15 eos/HPF in the distal esophagus only (n = 24), (2) at least 15 eos/HPF in the proximal esophagus only (n = 5), and (3) at least 15 eos/HPF in the distal and proximal biopsies (n = 33). Control groups included patients with GERD with biopsies containing 6 to 15 eos/HPF (n = 9), patients with GERD with 5 eos/HPF or less (n = 15), patients with candida esophagitis (n = 15), and patients with normal biopsies (n = 15). ALOX15 was positive in 90.5% of patients with EoE (13/16 in group 1, 4/4 in group 2, 31/33 in group 3) versus 44% of patients with GERD (4/8 in group 1, 0/1 in group 2, and 0/0 in group 3), 2 of 9 (22%) of patients with 6 to 15 eos/HPF, and was negative in all patients with GERD with biopsies containing 5 eos/HPF or less, all patients with candida esophagitis, and all normal controls. In conclusion, ALOX15 is a sensitive marker of EoE; however, subpopulations of patients with GERD with >5 eos/HPF also express ALOX15. Positive ALOX15 expression is more prevalent in EoE than in GERD and may prove to be a useful diagnostic marker in patients with discrepant biopsy findings between the proximal and distal esophagus.
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Andres
authors.initials: A
authors.lastname: Matoso
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Danisha
authors.initials: D
authors.lastname: Allen
authors.affiliation: Department of Pediatrics, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Michael
authors.initials: M
authors.lastname: Herzlinger
authors.affiliation: Department of Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Jason
authors.initials: J
authors.lastname: Ferreira
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Sonja
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Shaolei
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287.
authors.forename: Valeria
authors.initials: V
authors.lastname: Fabre
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Renee
authors.initials: R
authors.lastname: Monahan
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Dongfang
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Lelia
authors.initials: L
authors.lastname: Noble
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903.
authors.forename: Shamlal
authors.initials: S
authors.lastname: Mangray
authors.affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI 02903. Electronic address: mresnick@lifespan.org.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Resnick
mesh_terms: D001093:Arachidonate 15-Lipoxygenase / Q000032:analysis / Q000096:biosynthesis; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000378:metabolism; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C515716:ALOX15 protein, human; D001093:Arachidonate 15-Lipoxygenase
keywords: ALOX15; Biomarker; Eosinophilic esophagitis