Biomaterial Database

Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet. 2017

Marijn J Warners, and Berber J Vlieg-Boerstra, and Joanne Verheij, and Patricia H P van Hamersveld, and Bram D van Rhijn, and Marleen T J Van Ampting, and Lucien F Harthoorn, and Wouter J de Jonge, and Andreas J P M Smout, and Albert J Bredenoord

Department of Gastroenterology &Hepatology, Academic Medical Center, Amsterdam, The Netherlands.

OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

UI	MeSH Term	Description	Entries
D007413	Intestinal Mucosa	Lining of the INTESTINES, consisting of an inner EPITHELIUM, a middle LAMINA PROPRIA, and an outer MUSCULARIS MUCOSAE. In the SMALL INTESTINE, the mucosa is characterized by a series of folds and abundance of absorptive cells (ENTEROCYTES) with MICROVILLI.	Intestinal Epithelium,Intestinal Glands,Epithelium, Intestinal,Gland, Intestinal,Glands, Intestinal,Intestinal Gland,Mucosa, Intestinal
D007421	Intestine, Small	The portion of the GASTROINTESTINAL TRACT between the PYLORUS of the STOMACH and the ILEOCECAL VALVE of the LARGE INTESTINE. It is divisible into three portions: the DUODENUM, the JEJUNUM, and the ILEUM.	Small Intestine,Intestines, Small,Small Intestines
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D011446	Prospective Studies	Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.	Prospective Study,Studies, Prospective,Study, Prospective
D004947	Esophagus	The muscular membranous segment between the PHARYNX and the STOMACH in the UPPER GASTROINTESTINAL TRACT.
D005260	Female		Females
D005526	Food, Formulated	Food and dietary formulations including elemental (chemically defined formula) diets, synthetic and semisynthetic diets, space diets, weight-reduction formulas, tube-feeding diets, complete liquid diets, and supplemental liquid and solid diets.	Diet, Chemically Defined,Diet, Elemental,Diet, Formula,Diet, Synthetic,Dietary Formulations,Chemically Defined Diet,Synthetic Diet,Chemically Defined Diets,Dietary Formulation,Diets, Chemically Defined,Diets, Elemental,Diets, Formula,Diets, Synthetic,Elemental Diet,Elemental Diets,Foods, Formulated,Formulated Food,Formulated Foods,Formulation, Dietary,Formulations, Dietary
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000091344	Filaggrin Proteins	S100 proteins that aggregate KERATINS. Filaggrin precursor proteins are localized in keratohyalin granules and processed into individual functional filaggrin molecules during terminal epidermis differentiation. Mutations in fillagrins are associated with ICHTHYOSIS VULGARIS.	Filaggrin,Filaggrin Protein,Profilaggrin,Stratum Corneum Basic Protein,Stratum Corneum Basic Protein Precursor,Protein, Filaggrin,Proteins, Filaggrin