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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

Journal of Neurogastroenterology and Motility 2019년 25권 4호 p.525 ~ 533
김가희 ( Kim Ga-Hee ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology

 ( Park Young-Soo ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
정기욱 ( Jung Kee-Wook ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
 ( Kim Mi-Mi ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
 ( Na Hee-Kyong ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
안지용 ( Ahn Ji-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
이정훈 ( Lee Jeong-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
김도훈 ( Kim Do-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
최기돈 ( Choi Kee-Don ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
송호준 ( Song Ho-June ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
이진혁 ( 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
정훈용 ( 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 ≥ 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 (± 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.

키워드

Endoscopy; Eosinophilic esophagitis; Esophagus
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