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
±è°¡Èñ, ¹Ú¿µ¼ö, Á¤±â¿í, ±è¹Ì¹Ì, ³ªÈñ°æ, ¾ÈÁö¿ë, ÀÌÁ¤ÈÆ, ±èµµÈÆ, Ãֱ⵷, ¼ÛÈ£ÁØ, ÀÌÁøÇõ, Dellon Evan S., Á¤ÈÆ¿ë,
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±è°¡Èñ ( Kim Ga-Hee )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
¹Ú¿µ¼ö ( Park Young-Soo )
University of Ulsan College of Medicine Asan Medical Center Department of Pathology
Á¤±â¿í ( Jung Kee-Wook )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
±è¹Ì¹Ì ( Kim Mi-Mi )
University of Ulsan College of Medicine Asan Medical Center Department of Pathology
³ªÈñ°æ ( Na Hee-Kyong )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
¾ÈÁö¿ë ( Ahn Ji-Yong )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
ÀÌÁ¤ÈÆ ( Lee Jeong-Hoon )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
±èµµÈÆ ( Kim Do-Hoon )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
Ãֱ⵷ ( Choi Kee-Don )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
¼ÛÈ£ÁØ ( Song Ho-June )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
ÀÌÁøÇõ ( Lee Gin-Hyug )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
( Dellon Evan S. )
University of North Carolina School of Medicine Department of Medicine
Á¤ÈÆ¿ë ( Jung Hwoon-Yong )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
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 ¡Ã 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 (¡¾ 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.
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Endoscopy; Eosinophilic esophagitis; Esophagus
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