allergic esophagitis Eosinophilic esophagitis
Conditions
Interventions
None listed
Sponsors
Academisch Medisch Centrum
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: Patients -Previous diagnosis of active EoE confirmed by histopathology e.g. presence of >15 eosinophilic granulocytes per high power field (hpf) in mid or proximal esophageal biopsies -Macroscopic disease remission or significant mucosal healing after four weeks of treatment with an elemental or elimination diet -Written informed consent -Age 18 * 75 years;Healthy control group - Written informed consent - Age 18 * 75 years - Absence of atopic diseases - Absence of gastrointestinal symptoms
Exclusion criteria
Exclusion criteria: Patients - Inability to stop topical corticosteroids - Inability to stop beta-blockers and ACE inhibitors - Use of oral or systemic antihistaminics, oral cromoglicates, systemic corticosteroids, leukotriene inhibitors, or monoclonal antibodies, in the month preceding the study - Proven gastroesophageal reflux disease or other cause for esophageal eosinophilia - History of peptic ulcer disease - History of Barrett*s esophagus - History of GI cancer - History of GI tract surgery (except appendectomy) - ASA class III, IV or V - History of anaphylaxis - History of a severe systemic reaction to previous allergy tests (grade 3 or 4);Healthy controls - History of atopic diseases - Inability to stop beta-blockers and ACE inhibitors - Use of oral or systemic antihistaminics, oral cromoglicates, systemic corticosteroids, leukotriene inhibitors, or monoclonal antibodies, in the month preceding the study - Proven gastroesophageal reflux disease or other cause for esophageal eosinophilia - History of peptic ulcer disease - History of Barrett*s esophagus - History of GI cancer - History of GI tract surgery (except appendectomy) - ASA class III, IV or V - History of anaphylaxis - History of a severe systemic reaction to previous allergy tests (grade 3 or 4)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Visible immune response to allergens injected into the esophageal mucosa, defined as wheal and flare reaction. 2. In vitro immune response of esophageal mucosal tissue in culture medium to added allergenic solutions, defined as release of inflammatory cytokines, histamine and tryptase. | — |
Secondary
| Measure | Time frame |
|---|---|
| Clinical parameters: - Symptom-Based Activity Index EoE (EEsAI) - General allergy questionnaire - Correlation between clinical symptoms and positive wheal and flare reactions - Evaluation allergic / atopic history Sensitization patterns on standard allergy testing: - Skin Prick test - Allergen specific serum IgE testing (ImmunoCap) Endoscopic evaluation: - Endoscopic features (recorded by video and still images) - Delayed esophageal hypersensitivity reaction (wheal and flare after 24 hours) Measures of mucosal barrier function: - Esophageal intestinal mucosal integrity measured in vivo by electrical tissue impedance spectroscopy before and after allergen injection Laboratory investigations EPT and after in vitro allergen provocation: - Histological evaluation of two esophageal biopsies to determine peak eosinophil count and mast cell counts after dietary treatment - Local allergen-specific IgE production, measured as percent of tissue area labeled by IgE-positive cells in the biopsy specimens - Esophageal immune activation (eosinophil, mast cells and inflammatory cytokines histamine and tryptase counts) | — |
Countries
Netherlands
Outcome results
None listed