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Poor Relationship Between Fractionated Exhaled Nitric Oxide and Disease Activity in Eosinophilic Esophagitis

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Abstract

Current eosinophilic esophagitis care requires monitoring with repeat endoscopy and biopsy, which has significant cost, risk, and inconvenience for patients. Fractionated exhaled nitric oxide testing (FeNO) is a standardized non-invasive test with proven utility in evaluation of asthma. Elevated FeNO has reported use in other eosinophilic inflammatory conditions; however, its use in eosinophilic esophagitis has not been fully evaluated. To assess the utility of FeNO in predicting severity of eosinophilic esophagitis activity. Fifty patients received fractionated exhaled nitric oxide testing within 1 week of endoscopic evaluation with biopsy for determination of peak eosinophil counts. Presence of furrows was also evaluated with respect to FeNO levels. Spearman correlation was calculated between FeNO and peak eosinophil counts (PEC) with subgroup analysis performed based on PPI use. Spearman correlation was performed on the change in FeNO and PEC on the patients receiving repeat testing. FeNO was poorly correlated to PEC (Spearman correlation 0.22). With a cut-off FeNO value of > 40 ppb, specificity of FeNO for detecting presence of ≥ 15 eos/hpf was 0.94 and sensitivity was 0.16. FeNO showed weak relationship to presence of furrows. Within the subgroup of patients not taking PPI, the spearman correlation was 0.21. Delta- FeNO versus Delta-PEC had spearman correlation of 0.72 for patients receiving repeat testing. FeNO likely has limited clinical utility for predicting severity of esophageal eosinophilia. In patients with FeNO levels > 40 ppb, specificity of testing was high, but very few patients reached this FeNO level.

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Acknowledgements

All authors approved of the final version to be published. We thank the Mayo Gastroenterology fellows who work in the EoE clinic and help care for the patients participating in this study. We also thank our expert pathologists who reviewed the biopsy samples. This publication was made possible by the Mayo Clinic CTSA through Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH).

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Authors and Affiliations

  1. Internal Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA

    Kimberly Johnson

  2. Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA

    Vivek Iyer

  3. Gastroenterology and Hepatology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA

    David Katzka, Karthik Ravi & Jeffrey Alexander

  4. Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA

    Ryan Lennon, Richard Pendegraft & Debra Geno

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  1. Kimberly Johnson
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Correspondence to Jeffrey Alexander.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Johnson, K., Iyer, V., Katzka, D. et al. Poor Relationship Between Fractionated Exhaled Nitric Oxide and Disease Activity in Eosinophilic Esophagitis. Dysphagia 34, 138–144 (2019). https://doi.org/10.1007/s00455-018-9925-4

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  • DOI: https://doi.org/10.1007/s00455-018-9925-4

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