Eosinophilic Esophagitis Pathophysiology: The Role of Intrabolus
Pressure, Proteomic, and Histological Analysis as Predictive Tools
Abstract
Background: Eosinophilic esophagitis (EoE) is a recently defined chronic
immune-mediated disease of atopic etiology with esophageal dysfunction
and mucosal eosinophilic infiltrate. Among esophageal high-resolution
manometry (HRM) parameters, intrabolus pressure (IBP) has shown the
possibility to distinguish patients with mucosal inflammation, who
benefit from proton pump inhibitors (PPI), from those with initial
fibrosis and lack of response to treatment. In this study, we aimed to
identify biomarkers able to identify which group a patient belongs to
and obtain an early response. Methods: Combining diagnostic and
esophageal function tests, proteomic and histological
immunohistochemical analysis we studied 24 patients with EoE to
extrapolate a protein profile from biopsies of the middle third of the
esophagus analysis. Among them, 20 patients also underwent esophageal
HRM. Results: IBP values were found to be significantly different among
the controls, responsive and non-responsive patients, in relation to PPI
treatment. Proteomic analysis identified 1,445 proteins, 456 shared
between the two groups of patients, with 58 proteins identified as
differentially expressed (DEPs) between the two groups of patients.
Among all identified proteins, we found that, by immunohistochemistry,
Gal-3 was overexpressed in patients’ responder to PPI, and with image
analysis the difference between the two groups was statistically
significant (% positive cells p<0.01, % positive area
p<0.005) Conclusions: This study showed the chance of knowing
forward the response to PPI therapy, improving patients’ personalized
therapy and quality of life.