Abstract：
BACKGROUND: Recurrent upper endoscopies are essential for monitoring therapy response and disease activity in patients with eosinophilic esophagitis (EoE), leading to increased costs, procedural complications, and anesthesia exposure. The aim of this study was to examine an office-based model using serial sedation-free blind esophageal epithelial brushing (BEEB) to monitor therapy response through eosinophil-derived neurotoxin (EDN) levels and guide therapy plans in pediatric EoE patients.
METHODS: EoE patients (≤21 years of age) were enrolled in this prospective study. Subjects were placed on dietary, pharmacologic, or combination therapy with the goal of inducing or maintaining remission. To assess response to sequential interventions, subjects underwent sequential sedation-free BEEBs through nasogastric tubes to measure EDN levels. Based on serial brushings, an individual plan of diet, medications, or a combination of both was created for each subject, and a final endoscopy was then performed to validate the accuracy of the individual plans.
RESULTS: Twenty-four subjects completed the study. The average peak eosinophil count in patients with active EoE was 58.1 ± 30.8 eosinophils per high-power field and mean EDN level was 165.2 ± 191.3 μg/mL. A total of 42 BEEBs were completed. Individual therapy plans based on sequential BEEB were accurate in 19 out of the 24 patients (79%) and specifically nine out of 10 patients (90%) treated with elimination diets.
CONCLUSIONS: This study suggests that office-based sedation-free BEEBs can be used to monitor therapy response and disease activity in pediatric EoE patients.
METHODS: EoE patients (≤21 years of age) were enrolled in this prospective study. Subjects were placed on dietary, pharmacologic, or combination therapy with the goal of inducing or maintaining remission. To assess response to sequential interventions, subjects underwent sequential sedation-free BEEBs through nasogastric tubes to measure EDN levels. Based on serial brushings, an individual plan of diet, medications, or a combination of both was created for each subject, and a final endoscopy was then performed to validate the accuracy of the individual plans.
RESULTS: Twenty-four subjects completed the study. The average peak eosinophil count in patients with active EoE was 58.1 ± 30.8 eosinophils per high-power field and mean EDN level was 165.2 ± 191.3 μg/mL. A total of 42 BEEBs were completed. Individual therapy plans based on sequential BEEB were accurate in 19 out of the 24 patients (79%) and specifically nine out of 10 patients (90%) treated with elimination diets.
CONCLUSIONS: This study suggests that office-based sedation-free BEEBs can be used to monitor therapy response and disease activity in pediatric EoE patients.
摘要：
背景：反复上镜检查对于监测嗜酸性粒细胞性食管炎（EoE）患者的治疗反应和疾病活动至关重要，导致成本增加，手术并发症,和麻醉暴露。这项研究的目的是使用连续无镇静盲食道上皮刷洗（BEEB）检查基于办公室的模型，以通过嗜酸性粒细胞衍生的神经毒素（EDN）水平监测治疗反应，并指导儿科EoE患者的治疗计划。
方法：EoE患者（≤21岁）纳入本前瞻性研究。受试者被放在饮食上，药理学,或联合治疗，目的是诱导或维持缓解。为了评估对序贯干预的反应，受试者通过鼻胃管进行序贯无镇静BEEB以测量EDN水平.基于连环笔触，个人的饮食计划，药物,或者为每个主题创建了两者的组合，然后进行最终内窥镜检查以验证各个计划的准确性.
结果：24名受试者完成了研究。EoE活跃患者的平均嗜酸性粒细胞峰值计数为每个高倍视野58.1±30.8嗜酸性粒细胞，平均EDN水平为165.2±191.3μg/mL。总共完成了42个BEEB。基于序贯BEEB的个体治疗计划在24例患者中有19例（79％）准确，特别是在10例患者中有9例（90％）接受消除饮食治疗。
结论：这项研究表明，基于办公室的无镇静BEEB可用于监测儿科EoE患者的治疗反应和疾病活动。
方法：EoE患者（≤21岁）纳入本前瞻性研究。受试者被放在饮食上，药理学,或联合治疗，目的是诱导或维持缓解。为了评估对序贯干预的反应，受试者通过鼻胃管进行序贯无镇静BEEB以测量EDN水平.基于连环笔触，个人的饮食计划，药物,或者为每个主题创建了两者的组合，然后进行最终内窥镜检查以验证各个计划的准确性.
结果：24名受试者完成了研究。EoE活跃患者的平均嗜酸性粒细胞峰值计数为每个高倍视野58.1±30.8嗜酸性粒细胞，平均EDN水平为165.2±191.3μg/mL。总共完成了42个BEEB。基于序贯BEEB的个体治疗计划在24例患者中有19例（79％）准确，特别是在10例患者中有9例（90％）接受消除饮食治疗。
结论：这项研究表明，基于办公室的无镇静BEEB可用于监测儿科EoE患者的治疗反应和疾病活动。
