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Eozinofilik özofajit tanısında fekal kalprotektin, ECP, IL-5 ve IL-13'ün kullanımı

Year 2024, Volume: 7 Issue: 2, 175 - 181, 30.06.2024

Abstract

Amaç: Eozinofilik özofajit (EoE), kronik, eozinofilik inflamasyonun özofagus fonksiyon bozukluğu semptomlarıyla sonuçlandığı, Th2, antijen kaynaklı bir hastalıktır. Ayırıcı tanıda pek çok hastalık vardır, en önemlisi peptik özofajittir (PÖ). Bu iki hastalığın ayrımını yapmada ve eozinofilik özofajit tanısında fekal kalprotektin, ECP, IL-5 ve IL-13'ün kullanımını araştırmayı amaçladık.
Yöntem: Gastroskopi uygulanan, makroskobik ve/veya mikroskobik patolojik bulguları EoE veya PE ile uyumlu olan 64 çocuk çalışmaya alındı. Kalproteiktin düzeyi, eozinofilik katyonik protein (ECP), IL-5, IL-13 incelendi ve sağlıklı kontrollerle karşılaştırıldı.
Bulgular: Eozinofil sayısı, CRP, toplam IgE, serum IL-5, IL-13 ve kalprotektin düzeyleri, kontrol grubuna kıyasla EoE grubunda anlamlı derecede yüksekti (P<0.05). Lökosit sayısı, AEC, CRP, toplam IgE, ECP ve serum IL-5 düzeyleri peptik özofajit grubuna kıyasla EoE grubunda anlamlı derecede yüksekti (P<0.05). Kalprotektin düzeyi EoE'li hastalarda PÖ’lü hastalara göre daha yüksekti ancak istatistiksel olarak anlamlı bir fark yoktu (P=0.055). Total IgE değeri (r=0,489) ve ECP (r=0,810) EoE'deki doku eozinofil sayısı ile koreleydi (P=0,001; <0,001)
Sonuç: Eozinofilik özofajit ayırıcı tanısında ECP'nin kullanılabileceği, kalprotektinin klinik uygulamada bir belirteç olarak yaygın olarak kullanılabilmesi için daha fazla sayıda hastayı içeren daha fazla çalışmaya ihtiyaç vardır.

Ethical Statement

Istanbul University Cerrahpaşa Medical Faculty Clinical Research Ethics Committee (2012/10051).

Supporting Institution

This project was funded by Istanbul University Scientific Research Projects Unit (SRP) with the number of 23339 and Turkish Pediatrics Association expenditures for analysis of FC and interleukins.

Project Number

Istanbul University Cerrahpaşa Medical Faculty Clinical Research Ethics Committee (2012/10051).

References

  • van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;341:c3369. Published 2010 Jul 15. doi:10.1136/bmj.c3369
  • Fagerberg UL, Lööf L, Lindholm J, Hansson LO, Finkel Y. Fecal calprotectin: a quantitative marker of colonic inflammation in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2007;45(4):414-420. doi:10.1097/MPG.0b013e31810e75a9
  • Quitadamo P, Papadopoulou A, Wenzl T, et al. European pediatricians' approach to children with GER symptoms: survey of the implementation of 2009 NASPGHAN-ESPGHAN guidelines. J Pediatr Gastroenterol Nutr. 2014;58(4):505-509. doi:10.1097/MPG.0b013e3182a69912
  • Aksoy ÖY, Canan O, Hoşnut FÖ, Akçay E, Özçay F. Fecal calprotectin levels in Helicobacter pylori gastritis in children. Turk J Pediatr. 2020;62(6):986-993. doi:10.24953/turkjped.2020.06.010
  • Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128(1):3-22. doi:10.1016/j.jaci.2011.02.040
  • Gonsalves NP, Aceves SS. Diagnosis and treatment of eosinophilic esophagitis. J Allergy Clin Immunol. 2020;145(1):1-7. doi:10.1016/j.jaci.2019.11.011
  • Poddar U. Gastroesophageal reflux disease (GERD) in children. Paediatr Int Child Health. 2019;39(1):7-12. doi:10.1080/20469047.2018.1489649
  • Sherman PM, Hassall E, Fagundes-Neto U, et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. 2009;104(5):1278-1296. doi:10.1038/ajg.2009.129
  • Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. doi:10.1097/MPG.0000000000001889
  • Deal L, Gold BD, Gremse DA, et al. Age-specific questionnaires distinguish GERD symptom frequency and severity in infants and young children: development and initial validation. J Pediatr Gastroenterol Nutr. 2005;41(2):178-185. doi:10.1097/01.mpg.0000172885.77795.0f
  • Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. 2004;351(9):940-941. doi:10.1056/NEJM200408263510924
  • Spergel JM, Brown-Whitehorn TF, Beausoleil JL, et al. 14 years of eosinophilic esophagitis: clinical features and prognosis. J Pediatr Gastroenterol Nutr. 2009;48(1):30-36. doi:10.1097/MPG.0b013e3181788282
  • Sherrill JD, Rothenberg ME. Genetic dissection of eosinophilic esophagitis provides insight into disease pathogenesis and treatment strategies. J Allergy Clin Immunol. 2011;128(1):23-34. doi:10.1016/j.jaci.2011.03.046
  • Gonsalves N. Distinct features in the clinical presentations of eosinophilic esophagitis in children and adults: is this the same disease?. Dig Dis. 2014;32(1-2):89-92. doi:10.1159/000357078
  • Blanchard C, Wang N, Rothenberg ME. Eosinophilic esophagitis: pathogenesis, genetics, and therapy. J Allergy Clin Immunol. 2006;118(5):1054-1059. doi:10.1016/j.jaci.2006.07.038
  • Bakirtaş A, Arga M, Eğrıtaş O, et al. The first experience of eosinophilic esophagitis in Turkish children. Turk J Gastroenterol. 2012;23(1):1-7.
  • Rizo Pascual JM, De La Hoz Caballer B, Redondo Verge C, et al. Allergy assessment in children with eosinophilic esophagitis. J Investig Allergol Clin Immunol. 2011;21(1):59-65.
  • Al-Hussaini A, Al-Idressi E, Al-Zahrani M. The role of allergy evaluation in children with eosinophilic esophagitis. J Gastroenterol. 2013;48(11):1205-1212. doi:10.1007/s00535-012-0741-6
  • Arora AA, Weiler CR, Katzka DA. Eosinophilic esophagitis: allergic contribution, testing, and management. Curr Gastroenterol Rep. 2012;14(3):206-215. doi:10.1007/s11894-012-0254-8
  • Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA. Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2010;104(6):496-502. doi:10.1016/j.anai.2010.03.018
  • Rodríguez-Sánchez J, Gómez-Torrijos E, de-la-Santa-Belda E, et al. Effectiveness of serological markers of eosinophil activity in monitoring eosinophilic esophagitis. Rev Esp Enferm Dig. 2013;105(8):462-467. doi:10.4321/s1130-01082013000800004
  • Cheng KJ, Xu YY, Liu HY, Wang SQ. Serum eosinophil cationic protein level in Chinese subjects with nonallergic and local allergic rhinitis and its relation to the severity of disease. Am J Rhinol Allergy. 2013;27(1):8-12. doi:10.2500/ajra.2013.27.3845
  • Koh GC, Shek LP, Goh DY, Van Bever H, Koh DS. Eosinophil cationic protein: is it useful in asthma? A systematic review. Respir Med. 2007;101(4):696-705. doi:10.1016/j.rmed.2006.08.012
  • Kato M, Yamada Y, Maruyama K, Hayashi Y. Serum eosinophil cationic protein and 27 cytokines/chemokines in acute exacerbation of childhood asthma. Int Arch Allergy Immunol. 2010;152 Suppl 1:62-66. doi:10.1159/000312127
  • Cengiz C. Serum eosinophilic cationic protein is correlated with food impaction and endoscopic severity in eosinophilic esophagitis. Turk J Gastroenterol. 2019 Apr;30(4):345-349. doi: 10.5152/tjg.2019.18529. PMID: 30945644; PMCID: PMC6453650.
  • Beşer OF, Sancak S, Erkan T, Kutlu T, Cokuğraş H, Cokuğraş FÇ. Can Fecal Calprotectin Level Be Used as a Markers of Inflammation in the Diagnosis and Follow-Up of Cow's Milk Protein Allergy?. Allergy Asthma Immunol Res. 2014;6(1):33-38. doi:10.4168/aair.2014.6.1.33
  • Berni Canani R, Rapacciuolo L, Romano MT, et al. Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice. Dig Liver Dis. 2004;36(7):467-470. doi:10.1016/j.dld.2004.02.009

The utility of faecal calprotectin, ECP, IL-5 and IL-13 in the diagnosis of eosinophilic esophagitis

Year 2024, Volume: 7 Issue: 2, 175 - 181, 30.06.2024

Abstract

Objectives: Eosinophilic esophagitis (EoE) is a Th2, antigen driven disease in which chronic, eosinophilic inflammation results with symptoms of esophageal dysfunction. There are many diseases in the differential diagnosis, the most important one is peptic esophagitis (PE). We aimed to investigate the use of fecal calprotectin, ECP, IL-5 and IL-13 in distinguishing these two diseases and in the diagnosis of eosinophilic esophagitis.
Methods: 64 children who had gastroscopic examination and who had macroscopic and/or microscopic pathologic findings compatible with EoE or PE were enrolled. The FC level, complete blood count, C reactive protein (CRP), eosinophilic cationic protein (ECP), total immunoglobulin E (IgE), specific IgE, IL-5, IL-13 were studied and compared with healthy controls (HCs).
Results: The eosinophil number, CRP, total IgE, serum IL-5, IL-13 and FC levels were significantly higher in the EoE group compared to the HCs (P<0.05). The leukocyte count, AEC, CRP, total IgE, ECP and serum IL-5 levels were significantly higher in the EoE group compared to the PE group (P<0.05). The FC level was higher in patients with EoE than ones with PE but there was no statistically significant difference (P=0.055). Total IgE value (r=0.489) and ECP (r=0.810) were correlated with the tissue eosinophil count in EoE (P=0.001; <0.001).
Conclusion: Our results suggest that FC and ECP can be used in the differential diagnosis of EoE. However, more studies including a higher number of patients are needed to use FC as a diagnostic marker widely in clinical practice.

Project Number

Istanbul University Cerrahpaşa Medical Faculty Clinical Research Ethics Committee (2012/10051).

References

  • van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;341:c3369. Published 2010 Jul 15. doi:10.1136/bmj.c3369
  • Fagerberg UL, Lööf L, Lindholm J, Hansson LO, Finkel Y. Fecal calprotectin: a quantitative marker of colonic inflammation in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2007;45(4):414-420. doi:10.1097/MPG.0b013e31810e75a9
  • Quitadamo P, Papadopoulou A, Wenzl T, et al. European pediatricians' approach to children with GER symptoms: survey of the implementation of 2009 NASPGHAN-ESPGHAN guidelines. J Pediatr Gastroenterol Nutr. 2014;58(4):505-509. doi:10.1097/MPG.0b013e3182a69912
  • Aksoy ÖY, Canan O, Hoşnut FÖ, Akçay E, Özçay F. Fecal calprotectin levels in Helicobacter pylori gastritis in children. Turk J Pediatr. 2020;62(6):986-993. doi:10.24953/turkjped.2020.06.010
  • Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128(1):3-22. doi:10.1016/j.jaci.2011.02.040
  • Gonsalves NP, Aceves SS. Diagnosis and treatment of eosinophilic esophagitis. J Allergy Clin Immunol. 2020;145(1):1-7. doi:10.1016/j.jaci.2019.11.011
  • Poddar U. Gastroesophageal reflux disease (GERD) in children. Paediatr Int Child Health. 2019;39(1):7-12. doi:10.1080/20469047.2018.1489649
  • Sherman PM, Hassall E, Fagundes-Neto U, et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. 2009;104(5):1278-1296. doi:10.1038/ajg.2009.129
  • Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. doi:10.1097/MPG.0000000000001889
  • Deal L, Gold BD, Gremse DA, et al. Age-specific questionnaires distinguish GERD symptom frequency and severity in infants and young children: development and initial validation. J Pediatr Gastroenterol Nutr. 2005;41(2):178-185. doi:10.1097/01.mpg.0000172885.77795.0f
  • Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. 2004;351(9):940-941. doi:10.1056/NEJM200408263510924
  • Spergel JM, Brown-Whitehorn TF, Beausoleil JL, et al. 14 years of eosinophilic esophagitis: clinical features and prognosis. J Pediatr Gastroenterol Nutr. 2009;48(1):30-36. doi:10.1097/MPG.0b013e3181788282
  • Sherrill JD, Rothenberg ME. Genetic dissection of eosinophilic esophagitis provides insight into disease pathogenesis and treatment strategies. J Allergy Clin Immunol. 2011;128(1):23-34. doi:10.1016/j.jaci.2011.03.046
  • Gonsalves N. Distinct features in the clinical presentations of eosinophilic esophagitis in children and adults: is this the same disease?. Dig Dis. 2014;32(1-2):89-92. doi:10.1159/000357078
  • Blanchard C, Wang N, Rothenberg ME. Eosinophilic esophagitis: pathogenesis, genetics, and therapy. J Allergy Clin Immunol. 2006;118(5):1054-1059. doi:10.1016/j.jaci.2006.07.038
  • Bakirtaş A, Arga M, Eğrıtaş O, et al. The first experience of eosinophilic esophagitis in Turkish children. Turk J Gastroenterol. 2012;23(1):1-7.
  • Rizo Pascual JM, De La Hoz Caballer B, Redondo Verge C, et al. Allergy assessment in children with eosinophilic esophagitis. J Investig Allergol Clin Immunol. 2011;21(1):59-65.
  • Al-Hussaini A, Al-Idressi E, Al-Zahrani M. The role of allergy evaluation in children with eosinophilic esophagitis. J Gastroenterol. 2013;48(11):1205-1212. doi:10.1007/s00535-012-0741-6
  • Arora AA, Weiler CR, Katzka DA. Eosinophilic esophagitis: allergic contribution, testing, and management. Curr Gastroenterol Rep. 2012;14(3):206-215. doi:10.1007/s11894-012-0254-8
  • Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA. Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2010;104(6):496-502. doi:10.1016/j.anai.2010.03.018
  • Rodríguez-Sánchez J, Gómez-Torrijos E, de-la-Santa-Belda E, et al. Effectiveness of serological markers of eosinophil activity in monitoring eosinophilic esophagitis. Rev Esp Enferm Dig. 2013;105(8):462-467. doi:10.4321/s1130-01082013000800004
  • Cheng KJ, Xu YY, Liu HY, Wang SQ. Serum eosinophil cationic protein level in Chinese subjects with nonallergic and local allergic rhinitis and its relation to the severity of disease. Am J Rhinol Allergy. 2013;27(1):8-12. doi:10.2500/ajra.2013.27.3845
  • Koh GC, Shek LP, Goh DY, Van Bever H, Koh DS. Eosinophil cationic protein: is it useful in asthma? A systematic review. Respir Med. 2007;101(4):696-705. doi:10.1016/j.rmed.2006.08.012
  • Kato M, Yamada Y, Maruyama K, Hayashi Y. Serum eosinophil cationic protein and 27 cytokines/chemokines in acute exacerbation of childhood asthma. Int Arch Allergy Immunol. 2010;152 Suppl 1:62-66. doi:10.1159/000312127
  • Cengiz C. Serum eosinophilic cationic protein is correlated with food impaction and endoscopic severity in eosinophilic esophagitis. Turk J Gastroenterol. 2019 Apr;30(4):345-349. doi: 10.5152/tjg.2019.18529. PMID: 30945644; PMCID: PMC6453650.
  • Beşer OF, Sancak S, Erkan T, Kutlu T, Cokuğraş H, Cokuğraş FÇ. Can Fecal Calprotectin Level Be Used as a Markers of Inflammation in the Diagnosis and Follow-Up of Cow's Milk Protein Allergy?. Allergy Asthma Immunol Res. 2014;6(1):33-38. doi:10.4168/aair.2014.6.1.33
  • Berni Canani R, Rapacciuolo L, Romano MT, et al. Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice. Dig Liver Dis. 2004;36(7):467-470. doi:10.1016/j.dld.2004.02.009
There are 27 citations in total.

Details

Primary Language English
Subjects Allergy, Gastroenterology and Hepatology
Journal Section Research Articles
Authors

Sibel Laçinel Gürlevik 0000-0001-9434-3597

Faruk Beser 0000-0001-8241-9531

Nuray Kepil 0000-0001-5494-6422

Dildar Konukoğlu 0000-0002-6095-264X

Sibel Erdamar 0000-0001-7470-8835

Tufan Kutlu 0000-0001-8396-4048

Fugen Cullu 0000-0003-0886-1422

Tulay Erkan 0000-0002-8924-2799

Project Number Istanbul University Cerrahpaşa Medical Faculty Clinical Research Ethics Committee (2012/10051).
Publication Date June 30, 2024
Submission Date March 3, 2024
Acceptance Date May 6, 2024
Published in Issue Year 2024 Volume: 7 Issue: 2

Cite

AMA Laçinel Gürlevik S, Beser F, Kepil N, Konukoğlu D, Erdamar S, Kutlu T, Cullu F, Erkan T. The utility of faecal calprotectin, ECP, IL-5 and IL-13 in the diagnosis of eosinophilic esophagitis. Acta Med Nicomedia. June 2024;7(2):175-181.

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