title: Utility of a Noninvasive Serum Biomarker Panel for Diagnosis and Monitoring of Eosinophilic Esophagitis: A Prospective Study.
abstract: OBJECTIVE
  Noninvasive biomarkers would be valuable for diagnosis and monitoring of eosinophilic esophagitis (EoE). The aim of this study was to determine the utility of a panel of serum biomarkers for the diagnosis and management of EoE.
  
  
  METHODS
  We conducted a prospective cohort study of consecutive adults undergoing outpatient esophagogastroduodenoscopy. Incident cases of EoE were diagnosed per consensus guidelines; controls had gastroesophageal reflux disease (GERD) or dysphagia and did not meet the EoE criteria. EoE cases were treated with topical steroids and had repeat endoscopy. Pre- and post-treatment serum samples were analyzed in a blinded manner for interleukin (IL)-4, IL-5, IL-6, IL-9, IL-13, transforming growth factor (TGF)-α, TGF-β, tumor necrosis factor-α, eotaxin-1, -2, and -3, thymic stromal lymphopoietin (TSLP), major basic protein, and eosinophil-derived neurotoxin. Cases and controls were compared at baseline, and pre- and post-treatment assays were compared in cases.
  
  
  RESULTS
  A total of 61 incident EoE cases and 87 controls were enrolled; 51 EoE cases had post-treatment serum analyzed. There were no significant differences in any of the biomarkers between EoE cases and controls at baseline. IL-13 and eotaxin-3 for cases and controls were 85 ± 160 vs. 43 ± 161 pg/ml (P=0.12) and 41 ± 159 vs. 21 ± 73 (P=0.30). There were no significant differences in assay values among cases before and after treatment. There were also no differences after stratification by atopic status or treatment response.
  
  
  CONCLUSIONS
  A panel of inflammatory factors known to be associated with EoE pathogenesis were not increased in the serum, nor were they responsive to therapy. None of these biomarkers are likely candidates for a serum test for EoE. Histologic analysis for diagnosis and management of EoE continues to be necessary, and novel, less invasive, biomarkers are needed.
authors.affiliation: 1] Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA [2] Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Spencer
authors.initials: S
authors.lastname: Rusin
authors.affiliation: Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Gebhart
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Covey
authors.affiliation: Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Leana L
authors.initials: LL
authors.lastname: Higgins
authors.affiliation: Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: RoseMary
authors.initials: R
authors.lastname: Beitia
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Speck
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Woodward
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Woosley
authors.affiliation: 1] Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA [2] Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
mesh_terms: D000328:Adult; D000368:Aged; D000730:Androstadienes / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood*; D019819:Budesonide / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood*; D003680:Deglutition Disorders / Q000097:blood; D016145:Endoscopy, Digestive System; D047093:Eosinophil Major Basic Protein / Q000097:blood; D047208:Eosinophil-Derived Neurotoxin / Q000097:blood; D057765:Eosinophilic Esophagitis / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D000068298:Fluticasone; D005764:Gastroesophageal Reflux / Q000097:blood; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015291:Transforming Growth Factors / Q000097:blood
chemical_list: D000730:Androstadienes; D015415:Biomarkers; D016207:Cytokines; D005938:Glucocorticoids; D019819:Budesonide; D015291:Transforming Growth Factors; D000068298:Fluticasone; D047208:Eosinophil-Derived Neurotoxin; D047093:Eosinophil Major Basic Protein