Poor Correlation of Oral Swabs with Esophageal Eosinophil Counts
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ORIGINAL ARTICLE
Poor Correlation of Oral Swabs with Esophageal Eosinophil Counts Vishal Avinashi1 · Justin M. Chan1 · Jonathan W. Bush2 · Bruce A. Vallance1 · Hyungjun Yang1 · Elodie Portales‑Casamar3 · Lianne Soller3 · Christopher Mill3 · Edmond S. Chan3 Received: 28 May 2019 / Accepted: 19 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Eosinophilic esophagitis (EoE) is a chronic condition that requires repeated endoscopies/biopsies to track the disease and treatment response. This invasive procedure involves risk to the patient and has significant costs. We studied whether the detection of specific proteins (cytokines and eosinophil degranulation products) from oral swabs could serve as a minimally invasive test for EoE. Swabs of the oral cavity (buccal and oropharyngeal) were obtained prior to endoscopy/biopsies in patients with EoE, possible EoE, and non-EoE patients in addition to obtaining additional esophageal biopsy tissue. ELISAs measuring the levels of cytokines IL-5, IL-8, IL-13, and eosinophil degranulation products including major basic protein (MBP), eosinophil derived neurotoxin (EDN), and eosinophil peroxidase (EPO) were performed on the samples. Comparisons were made to peak esophageal eosinophil counts. Tolerability of the swabs was evaluated. 43 patients, 4–17 years old, participated in the study. Swabs were well tolerated and all showed measurable protein. 26 patients had EoE [14 active (> 15 eosinophils/high power field), 12 non-active], 17 patients did not have EoE. Results obtained from oral swabs showed poor correlation with those from esophageal tissue. Only measurement of eosinophil degranulation products EDN and EPO from esophageal tissues showed strong correlations with eosinophil counts. In this study, the levels of cytokines and eosinophil degranulation products detected from oral swabs did not correlate with esophageal eosinophilia, and their detection would be insufficient to displace endoscopy/biopsies. Keywords EoE · Minimally invasive · Oral swab · Endoscopy · ELISA
Introduction Eosinophilic esophagitis (EoE) is an increasingly common chronic inflammatory disease of the esophagus occurring in children, and often with co-existing allergic diseases. At present, beyond following symptoms which do not show great correlation with disease activity, patients need the “gold standard” of endoscopy and biopsy to evaluate disease * Vishal Avinashi [email protected] 1
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, BC Children’s Hospital, and University of British Columbia, 4480 Oak Street, Vancouver, BC V63V4, Canada
2
Department of Pathology and Laboratory Medicine, BC Children’s Hospital, and University of British Columbia, Vancouver, Canada
3
Division of Allergy and Immunology, Department of Pediatrics, BC Children’s Hospital, and University of British Columbia, Vancouver, Canada
status and treatment response, which for children is typically performed in a pediatric tertiary referra
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