Swathi Eluri1, Sara R Selitsky2, Irina Perjar3, Johnathan Hollyfield3, Renee Betancourt3, Cara Randall3, Spencer Rusin3, John T Woosley3, Nicholas J Shaheen1, Evan S Dellon4. 1. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 2. Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 3. Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 4. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: edellon@med.unc.edu.
Abstract
BACKGROUND & AIMS: Few factors have been identified that can be used to predict response of patients with eosinophilic esophagitis (EoE) to topical steroid treatment. We aimed to determine whether baseline clinical, endoscopic, histologic, and molecular features of EoE can be used to predict histologic response. METHODS: We collected data from 97 patients with EoE, from 2009 through 2015, treated with a topical steroid for 8 weeks; 59 patients had a histologic response to treatment. Baseline clinicopathologic features and gene expression patterns were compared between patients with a histologic response to treatment (<15 eos/hpf) and non-responders (≥15 eos/hpf). We performed sensitivity analyses for alternative histologic response definitions. Multivariate logistic regression was performed to identify predictive factors associated with response to therapy, which were assessed with area under the receiver operator characteristic (AUROC) curves. RESULTS: Baseline dilation was the only independent predictor of non-response (odds ratio [OR], 0.30; 95% CI, 0.10-0.89). When an alternate response (<1 eos/hpf) and non-response (<50% decrease in baseline eos/hpf) definition was used, independent predictors of response status were age (OR, 1.08; 95% CI, 1.02-1.14), food allergies (OR, 12.95; 95% CI, 2.20-76.15), baseline dilation (OR, 0.17; 95% CI, 0.03-0.88), edema or decreased vascularity (OR, 0.20; 95% CI, 0.04-1.03), and hiatal hernia (OR, 0.07; 95% CI, 0.01-0.66). Using these 5 factors, we developed a predictive model that discriminated complete responders from non-responders with an AUROC of 0.88. Baseline gene expression patterns were not associated with treatment response and did not change with different histologic response thresholds. CONCLUSIONS: In an analysis of 97 patients with EoE, we found dilation to be the only baseline factor associated with non-response to steroid treatment (<15 eos/hpf). However, a model comprising 5 clinical, endoscopic, and histologic factors identified patients with a complete response (<1 eos/hpf). A baseline gene expression panel was not predictive of treatment response at any threshold.
BACKGROUND & AIMS: Few factors have been identified that can be used to predict response of patients with eosinophilic esophagitis (EoE) to topical steroid treatment. We aimed to determine whether baseline clinical, endoscopic, histologic, and molecular features of EoE can be used to predict histologic response. METHODS: We collected data from 97 patients with EoE, from 2009 through 2015, treated with a topical steroid for 8 weeks; 59 patients had a histologic response to treatment. Baseline clinicopathologic features and gene expression patterns were compared between patients with a histologic response to treatment (<15 eos/hpf) and non-responders (≥15 eos/hpf). We performed sensitivity analyses for alternative histologic response definitions. Multivariate logistic regression was performed to identify predictive factors associated with response to therapy, which were assessed with area under the receiver operator characteristic (AUROC) curves. RESULTS: Baseline dilation was the only independent predictor of non-response (odds ratio [OR], 0.30; 95% CI, 0.10-0.89). When an alternate response (<1 eos/hpf) and non-response (<50% decrease in baseline eos/hpf) definition was used, independent predictors of response status were age (OR, 1.08; 95% CI, 1.02-1.14), food allergies (OR, 12.95; 95% CI, 2.20-76.15), baseline dilation (OR, 0.17; 95% CI, 0.03-0.88), edema or decreased vascularity (OR, 0.20; 95% CI, 0.04-1.03), and hiatal hernia (OR, 0.07; 95% CI, 0.01-0.66). Using these 5 factors, we developed a predictive model that discriminated complete responders from non-responders with an AUROC of 0.88. Baseline gene expression patterns were not associated with treatment response and did not change with different histologic response thresholds. CONCLUSIONS: In an analysis of 97 patients with EoE, we found dilation to be the only baseline factor associated with non-response to steroid treatment (<15 eos/hpf). However, a model comprising 5 clinical, endoscopic, and histologic factors identified patients with a complete response (<1 eos/hpf). A baseline gene expression panel was not predictive of treatment response at any threshold.
Authors: Julie M Caldwell; Carine Blanchard; Margaret H Collins; Philip E Putnam; Ajay Kaul; Seema S Aceves; Catherine A Bouska; Marc E Rothenberg Journal: J Allergy Clin Immunol Date: 2010-04 Impact factor: 10.793
Authors: D L Francis; A Foxx-Orenstein; A S Arora; T C Smyrk; K Jensen; S L Nord; J A Alexander; Y Romero; D A Katzka Journal: Aliment Pharmacol Ther Date: 2011-11-24 Impact factor: 8.171
Authors: Michael R Konikoff; Richard J Noel; Carine Blanchard; Cassie Kirby; Sean C Jameson; Bridget K Buckmeier; Rachel Akers; Mitchell B Cohen; Margaret H Collins; Amal H Assa'ad; Seema S Aceves; Philip E Putnam; Marc E Rothenberg Journal: Gastroenterology Date: 2006-08-16 Impact factor: 22.682
Authors: Chris A Liacouras; Glenn T Furuta; Ikuo Hirano; Dan Atkins; Stephen E Attwood; Peter A Bonis; A Wesley Burks; Mirna Chehade; Margaret H Collins; Evan S Dellon; Ranjan Dohil; Gary W Falk; Nirmala Gonsalves; Sandeep K Gupta; David A Katzka; Alfredo J Lucendo; Jonathan E Markowitz; Richard J Noel; Robert D Odze; Philip E Putnam; Joel E Richter; Yvonne Romero; Eduardo Ruchelli; Hugh A Sampson; Alain Schoepfer; Nicholas J Shaheen; Scott H Sicherer; Stuart Spechler; Jonathan M Spergel; Alex Straumann; Barry K Wershil; Marc E Rothenberg; Seema S Aceves Journal: J Allergy Clin Immunol Date: 2011-04-07 Impact factor: 10.793
Authors: Evan S Dellon; Karen J Fritchie; Tara C Rubinas; John T Woosley; Nicholas J Shaheen Journal: Dig Dis Sci Date: 2009-10-15 Impact factor: 3.199
Authors: Elizabeth T Schaefer; Joseph F Fitzgerald; Jean P Molleston; Joseph M Croffie; Marian D Pfefferkorn; Mark R Corkins; Joel D Lim; Steven J Steiner; Sandeep K Gupta Journal: Clin Gastroenterol Hepatol Date: 2008-02 Impact factor: 11.382
Authors: Richard J Noel; Philip E Putnam; Margaret H Collins; Amal H Assa'ad; Jesus R Guajardo; Sean C Jameson; Marc E Rothenberg Journal: Clin Gastroenterol Hepatol Date: 2004-07 Impact factor: 11.382
Authors: S S Aceves; R O Newbury; D Chen; J Mueller; R Dohil; H Hoffman; J F Bastian; D H Broide Journal: Allergy Date: 2009-10-01 Impact factor: 13.146
Authors: Su Jin Kim; Moo In Park; Gwang Ha Kim; Moon Won Lee; Kyoungwon Jung; Jin Lee; Sang Young Seol; Sam Ryong Jee; Hong Sub Lee; Jin Seok Jang; Jae Hwang Cha Journal: J Neurogastroenterol Motil Date: 2021-01-30 Impact factor: 4.924