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    One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis

    Ackerman, Steven J. and Kagalwalla, Amir F. and Hirano, Ikuo and Gonsalves, Nirmala and Katcher, Paul Menard and Gupta, S. and Wechsler, Joshua B. and Grozdanovic, Milica and Pan, Zhaoxing and Masterson, Joanne C. and Du, Jian and Fantus, Robert J. and Alumkal, Preeth and Lee, James J. and Ochkur, Sergei I. and Ahmed, Faria and Capocelli, Kelley E. and Melin-Aldana, Hector and Biette, K.A. and Dubner, Allison and Amsden, Katie and Keeley, Kaitlin and Sulkowski, Maureen and Zalewski, Angelika and Atkins, Dan and Furuta, Glenn T. (2019) One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis. The American Journal of Gastroenterology, 114. pp. 1614-1625. ISSN 0002-9270

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    OBJECTIVES: Eosinophilic esophagitis (EoE), a chronic food allergic disease, lacks sensitive and specific peripheral biomarkers. We hypothesized that levels of EoE-related biomarkers captured using a 1-hour minimally invasive Esophageal String Test (EST) would correlate with mucosal eosinophil counts and tissue concentrations of these same biomarkers. We aimed to determine whether a 1-hour EST accurately distinguishes active from inactive EoE or a normal esophagus. METHODS: In a prospective, multisite study, children and adults (ages 7–55 years) undergoing a clinically indicated esophagogastroduodenoscopy performed an EST with an esophageal dwell time of 1 hour. Subjects were divided into 3 groups: active EoE, inactive EoE, and normal esophageal mucosa. Eosinophil-associated protein levels were compared between EST effluents and esophageal biopsy extracts. Statistical modeling was performed to select biomarkers that best correlated with and predicted eosinophilic inflammation. RESULTS: One hundred thirty-four subjects (74 children, 60 adults) with active EoE (n 5 62), inactive EoE (n 5 37), and patient controls with a normal esophagus (n 5 35) completed the study. EST-captured eosinophil-associated biomarkers correlated significantly with peak eosinophils/high-power field, endoscopic visual scoring, and the same proteins extracted from mucosal biopsies. Statistical modeling, using combined eotaxin-3 and major basic protein-1 concentrations, led to the development of EoE scores that distinguished subjects with active EoE from inactive EoE or normal esophagi. Eightyseven percent of children, 95% of parents, and 92% of adults preferred the EST over endoscopy if it provided similar information. DISCUSSION: The 1-hour EST accurately distinguishes active from inactive EoE in children and adults and may facilitate monitoring of disease activity in a safe and minimally invasive fashion.

    Item Type: Article
    Additional Information: This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBYNC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Cite as: Ackerman SJ, Kagalwalla AF, Hirano I, Gonsalves N, Katcher PM, Gupta S, Wechsler JB, Grozdanovic M, Pan Z, Masterson JC, Du J, Fantus RJ, Alumkal P, Lee JJ, Ochkur S, Ahmed F, Capocelli K, Melin-Aldana H, Biette K, Dubner A, Amsden K, Keeley K, Sulkowski M, Zalewski A, Atkins D, Furuta GT. One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis. Am J Gastroenterol. 2019 Oct;114(10):1614-1625. doi: 10.14309/ajg.0000000000000371. PMID: 31567192; PMCID: PMC6784776.
    Keywords: One-Hour; Esophageal; String Test; Nonendoscopic; Minimally Invasive Test; Accurately; Detects; Disease Activity; Eosinophilic Esophagitis;
    Academic Unit: Faculty of Science and Engineering > Biology
    Item ID: 13997
    Identification Number:
    Depositing User: Joanne Masterson
    Date Deposited: 12 Feb 2021 10:41
    Journal or Publication Title: The American Journal of Gastroenterology
    Publisher: Lippincott, Williams & Wilkins
    Refereed: Yes
    Use Licence: This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available here

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