Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet

• Published in: The American journal of gastroenterology Vol. 112; no. 7; pp. 1061 - 1071
• Main Authors: Warners, Marijn J, Vlieg-Boerstra, Berber J, Verheij, Joanne, van Hamersveld, Patricia H P, van Rhijn, Bram D, Van Ampting, Marleen T J, Harthoorn, Lucien F, de Jonge, Wouter J, Smout, Andreas J P M, Bredenoord, Albert J
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.07.2017; Nature Publishing Group
• Subjects: Adult; Autoimmune diseases; Biopsy; Case-Control Studies; Electric Impedance; Endoscopy, Digestive System; Eosinophilic Esophagitis - diet therapy; Eosinophilic Esophagitis - pathology; Esophageal diseases; Esophagus; Esophagus - pathology; Female; Food, Formulated; Gastroenterology; Gastrointestinal diseases; Gene expression; Humans; Intestinal Mucosa - pathology; Intestine, Small - pathology; Male; Middle Aged; Permeability; Prospective Studies; Real-Time Polymerase Chain Reaction; Treatment Outcome
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1038/ajg.2017.107

The esophageal mucosal integrity is impaired in eosinophilic esophagitis (EoE) and it has been suggested that the duodenal permeability is increased. The absence of food allergens may restore the integrity. The aims of this study were to assess duodenal permeability in EoE and to evaluate the effect of an elemental diet on the esophageal and duodenal integrity. In this prospective study 17 adult EoE patients and 8 healthy controls (HC) were included. Esophageal biopsy specimens were sampled before and after 4 weeks of elemental diet to measure eosinophil counts and gene expression of tight junction and barrier integrity proteins. Esophageal and duodenal impedance were measured by electrical tissue impedance spectroscopy and Ussing chambers were used to measure transepithelial resistance (TER) and transepithelial molecule flux. Small intestinal permeability was measured using a test, measuring lactulose/mannitol (L/M) ratios. In EoE patients, the esophageal but not the duodenal integrity was impaired, compared with HC. We observed no significant difference between L/M ratios of HC and EoE patients. After diet, eosinophil counts decreased significantly, which was paralleled by normalization of esophageal impedance and transepithelial molecule flux. The esophageal TER improved significantly, but did not reach values seen in HC. Esophageal expression of genes encoding for barrier integrity proteins filaggrin and desmoglein-1 was impaired at baseline and restored after diet. An elemental diet restores esophageal integrity, suggesting that it is at least partly secondary to allergen exposure. Duodenal integrity seems not to be affected in EoE, and possibly plays a minor role in its pathophysiology.