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Allergy. 2010 Jan;65(1):109-16. doi: 10.1111/j.1398-9995.2009.02142.x. Epub 2009 Oct 1.

Resolution of remodeling in eosinophilic esophagitis correlates with epithelial response to topical corticosteroids.

Author information

1
Divisions of Allergy, Immunology, Rady Children's Hospital San Diego, University of California, San Diego, CA 92123, USA.

Abstract

BACKGROUND:

Esophageal remodeling occurs in eosinophilic esophagitis (EE) patients but whether the components of remodeling in the subepithelium are reversible by administration of topical oral corticosteroids is unknown.

METHODS:

We quantitated the degree of lamina propria remodeling in esophageal biopsies obtained before and after at least 3 months of therapy with budesonide in 16 pediatric EE subjects. In addition, we investigated whether corticosteroid therapy modulated vascular activation (expression of VCAM-1; level of interstitial edema), TGFbeta(1) activation (levels of TGFbeta(1), phosphorylated Smad2/3), and performed a pilot analysis of a polymorphism in the TGFbeta(1) promoter in relation to EE subjects who had reduced remodeling with budesonide therapy.

RESULTS:

EE subjects were stratified based on the presence (n = 9) or absence (n = 7) of decreased epithelial eosinophilia following budesonide. Patients with residual eosinophil counts of <or=7 eosinophils per high power field in the epithelial space (responders) demonstrated significantly reduced esophageal remodeling with decreased fibrosis, TGFbeta(1) and pSmad2/3 positive cells, and decreased vascular activation in association with budesonide therapy. Responders were more likely to have a CC genotype at the -509 position in the TGFbeta(1) promoter.

CONCLUSIONS:

Reductions in epithelial eosinophils following budesonide therapy were associated with significantly reduced esophageal remodeling.

PMID:
19796194
PMCID:
PMC2807896
DOI:
10.1111/j.1398-9995.2009.02142.x
[Indexed for MEDLINE]
Free PMC Article

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