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Poor Correlation of Oral Swabs with Esophageal Eosinophil Counts

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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.

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Acknowledgements

We would like to thank Boris Kuzeljevic, Michelle Dittrick, and the BCCH Biobank for their contributions to this project. Funding for this project was received from the BC Children’s Hospital Research Institute (BCCHRI), Childhood Disease Theme Microgrant and Applied Health Grant.

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Authors and Affiliations

  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

    Vishal Avinashi, Justin M. Chan, Bruce A. Vallance & Hyungjun Yang

  2. Department of Pathology and Laboratory Medicine, BC Children’s Hospital, and University of British Columbia, Vancouver, Canada

    Jonathan W. Bush

  3. Division of Allergy and Immunology, Department of Pediatrics, BC Children’s Hospital, and University of British Columbia, Vancouver, Canada

    Elodie Portales-Casamar, Lianne Soller, Christopher Mill & Edmond S. Chan

Authors
  1. Vishal Avinashi
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  2. Justin M. Chan
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  3. Jonathan W. Bush
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  4. Bruce A. Vallance
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  9. Edmond S. Chan
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Contributions

All authors have been part of the project from start to finish including designing the project, acquiring and analyzing data, as well as editing and reviewing the manuscript including the final draft.

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Correspondence to Vishal Avinashi.

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Conflict of interest

Dr. E.S. Chan is a member of the committee for the American Gastroenterological Institute & AAAAI/ACAAI Joint Task Force guidelines on the management of eosinophilic esophagitis. Outside of this paper, Dr. Chan has received research support from DBV Technologies, has been a member of advisory boards for Pfizer, Aralez Pharmaceuticals, Pediapharm, and Leo, is a member of the scientific advisory board for Food Allergy Canada, and was an expert panel and coordinating committee member of the National Institute of Allergy and Infectious Diseases (NIAID)-sponsored Guidelines for Peanut Allergy Prevention.

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Avinashi, V., Chan, J.M., Bush, J.W. et al. Poor Correlation of Oral Swabs with Esophageal Eosinophil Counts. Dysphagia 35, 773–779 (2020). https://doi.org/10.1007/s00455-019-10082-1

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  • DOI: https://doi.org/10.1007/s00455-019-10082-1

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