Monitoring pediatric eosinophilic esophagitis disease activity using an unsedated blind esophageal brushing model: A pilot study

BackgroundRecurrent upper endoscopies are essential for monitoring therapy response and disease activity in patients with eosinophilic esophagitis (EoE), leading to increased costs, procedural complications, and anesthesia exposure. The aim of this study was to examine an office-based model using serial sedation-free blind esophageal epithelial brushing (BEEB) to monitor therapy response through eosinophil-derived neurotoxin (EDN) levels and guide therapy plans in pediatric EoE patients.MethodsEoE patients (<= 21 years of age) were enrolled in this prospective study. Subjects were placed on dietary, pharmacologic, or combination therapy with the goal of inducing or maintaining remission. To assess response to sequential interventions, subjects underwent sequential sedation-free BEEBs through nasogastric tubes to measure EDN levels. Based on serial brushings, an individual plan of diet, medications, or a combination of both was created for each subject, and a final endoscopy was then performed to validate the accuracy of the individual plans.ResultsTwenty-four subjects completed the study. The average peak eosinophil count in patients with active EoE was 58.1 +/- 30.8 eosinophils per high-power field and mean EDN level was 165.2 +/- 191.3 mu g/mL. A total of 42 BEEBs were completed. Individual therapy plans based on sequential BEEB were accurate in 19 out of the 24 patients (79%) and specifically nine out of 10 patients (90%) treated with elimination diets.ConclusionThis study suggests that office-based sedation-free BEEBs can be used to monitor therapy response and disease activity in pediatric EoE patients. What is KnownIn eosinophilic esophagitis (EoE) patients, eosinophils deposit eosinophil-derived neurotoxin (EDN) on the luminal surface of the esophagus.EDN measured at 10 mu g/mL and higher in esophageal brushing samples obtained through a nasogastric tube (NGT) is highly sensitive (97%) and specific (89%) for the diagnosis of active EoE.Blind esophageal epithelial brushing obtained via an NGT is safe and well tolerated.What is NewBlind esophageal epithelial brushing can be used successfully to monitor therapy response and disease activity in pediatric patients with established EoE, especially those on elimination diets.