Subjects between the ages of 7 and 20 years who were undergoing an endoscopy with biopsy at either the Children's Hospital Colorado, Aurora, Colorado, USA or Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA to determine the causes of abdominal pain, vomiting, growth failure, dysphagia or histological efficacy of EoE treatment were enrolled in this study. Exclusion criteria included a history of oesophageal stenosis (stricture or narrowing), gelatin allergy or other causes that put subjects at increased risk (bleeding diatheses, connective tissue diseases) of endoscopic complications. Histories were taken to record symptoms, allergic history, family history and medications. Review of endoscopic and pathology records were performed to assure diagnostic accuracy and determine clinical features.
Subject diagnoses were assigned according to the following criteria based on published consensus recommendations:1 (link)
2 (link) (1) EoE-active: children with symptoms of oesophageal dysfunction and oesophageal eosinophilia >15 eosinophils/HPF, in whom other causes of symptoms and oesophageal eosinophilia were ruled out; (2) EoE-remission: children with EoE as defined above who had undergone at least 8 weeks of treatment (topical steroids or dietary elimination) and who, at the time of their endoscopy, were asymptomatic; (3) GORD: children with symptoms of vomiting or heartburn who had responded to proton pump inhibitor treatment and/or had an abnormal pH impedance monitor of the distal oesophagus. Subjects were on proton pump treatment at the time of the endoscopy; and (4) Normal: children with symptoms that lead to endoscopic testing who were found to have histologically normal oesophageal, gastric and duodenal mucosae.
The night before endoscopic procedures, subjects swallowed the Enterotest (online supplementary figure S1). Subjects could drink liquids until 3 h before their endoscopic procedure. If families or subjects desired, the subject was admitted to the Research Center (Clinical and Translational Research Center) at the Children's Hospital Colorado or Ann and Robert H Lurie Children's Hospital of Chicago the night before the procedure.
The day after swallowing the Enterotests, subjects had upper endoscopy performed. After anaesthesia was administered, the Enterotest was removed, adherent secretions were eluted from the proximal oesophageal section of the Enterotest and the sample was immediately frozen for later batch analysis of the ESGPs and CLC/Gal-10. The oesophageal string location was determined as noted below (online supplementary figure S1F). Mucosal pinch biopsies were then taken from oesophageal mucosal surfaces and immediately snap frozen for eosinophil-derived protein extraction and measurement. Diagnostic biopsies were placed in neutral buffered formalin for processing and routine H&E (eosinophil enumeration) and immunohistochemical (EPX Staining Index) staining.
This study was approved by the Colorado Multi-institutional IRB (COMIRB) and IRBs of the University of Illinois at Chicago and the Children's Memorial Hospital.
Subject diagnoses were assigned according to the following criteria based on published consensus recommendations:1 (link)
2 (link) (1) EoE-active: children with symptoms of oesophageal dysfunction and oesophageal eosinophilia >15 eosinophils/HPF, in whom other causes of symptoms and oesophageal eosinophilia were ruled out; (2) EoE-remission: children with EoE as defined above who had undergone at least 8 weeks of treatment (topical steroids or dietary elimination) and who, at the time of their endoscopy, were asymptomatic; (3) GORD: children with symptoms of vomiting or heartburn who had responded to proton pump inhibitor treatment and/or had an abnormal pH impedance monitor of the distal oesophagus. Subjects were on proton pump treatment at the time of the endoscopy; and (4) Normal: children with symptoms that lead to endoscopic testing who were found to have histologically normal oesophageal, gastric and duodenal mucosae.
The night before endoscopic procedures, subjects swallowed the Enterotest (online supplementary figure S1). Subjects could drink liquids until 3 h before their endoscopic procedure. If families or subjects desired, the subject was admitted to the Research Center (Clinical and Translational Research Center) at the Children's Hospital Colorado or Ann and Robert H Lurie Children's Hospital of Chicago the night before the procedure.
The day after swallowing the Enterotests, subjects had upper endoscopy performed. After anaesthesia was administered, the Enterotest was removed, adherent secretions were eluted from the proximal oesophageal section of the Enterotest and the sample was immediately frozen for later batch analysis of the ESGPs and CLC/Gal-10. The oesophageal string location was determined as noted below (online supplementary figure S1F). Mucosal pinch biopsies were then taken from oesophageal mucosal surfaces and immediately snap frozen for eosinophil-derived protein extraction and measurement. Diagnostic biopsies were placed in neutral buffered formalin for processing and routine H&E (eosinophil enumeration) and immunohistochemical (EPX Staining Index) staining.
This study was approved by the Colorado Multi-institutional IRB (COMIRB) and IRBs of the University of Illinois at Chicago and the Children's Memorial Hospital.
