Eosinophilic esophagitis is a childhood condition which is not yet fully understood. It involves the walls of the esophagus filling with lots of eosinophils -a type of white blood cell. These cells attack the esophagus by mistake, causing it to narrow until food can no longer pass.
Steven J. Ackerman of the UIC College of Medicine and Dr. Glenn T. Furuta, his colleague at the University of Colorado, Denver, were awarded three grants to help fight this devastating childhood disease. Ackerman and Furuta are co-principal investigators on the team, which also includes Dr. Amir Kagalwalla of the UIC Department of Pediatrics.
"Most cases are first encountered in the emergency room, where a child is brought in because something he ate is caught in his esophagus," said Ackerman, professor of biochemistry and molecular genetics at UIC.
Symptoms in children include trouble swallowing food, abdominal pain, nausea and vomiting.
To identify this disease, an endoscope is inserted into the esophagus to take tissue samples from various areas of the stomach. With the aid of a microscope, the number of eosinophils "which are not normally present in the esophagus at all," Ackerman said, are counted.
The procedure, he said, is not only expensive, but uncomfortable and carries some risks. And because repeat-testing is needed over the course of treatment, a child may need to undergo as many as 20 endoscopies within three or four years.
An endoscope is a minimally-invasive procedure that is used to study the interior surfaces of a particular organ by inserting a tube into the body. Most of these procedures involve a minimum amount of pain.
Ackerman believes that "the cost will end up be significantly less than the current costs of the multiple follow-up endoscopies with biopsy that are currently used to follow these EE patients."
Ackerman and his colleagues hope they can replace the endoscope by having
children swallow a string encased in a gelatin capsule. As the capsule
travels down the esophagus, the string plays out of the dissolving capsule, stretching through the esophagus, the stomach and the small intestine. The string is left in place overnight and then pulled out.
"We can determine which part of the string was in the esophagus, versus in the stomach, mouth or small intestine," said Ackerman. They then look on the string for certain inflammatory proteins that are expressed only by eosinophils. The test will be done the day before an endoscopic test is planned. The researchers will compare the thread's measures of the eosinophil proteins with the cell counts obtained by endoscopy.
"Eventually, of course, our hope is to replace these repeated endoscopies with this simple procedure," Ackerman said.
The investigators are also planning a proteomics study that will measure all the proteins on the string to develop a more complete diagnostic profile of the disease, Ackerman said. This swallowed string will one day hopefully replace the more invasive procedure which is currently used.
When asked what this might mean for future diagnoses, Dr. Ackerman replied, "It may not replace the initial endoscopy with biopsy for definitive diagnosis of EE, but if validated, could certainly replace the multiple subsequent endoscopies with biopsy currently used by many physicians to follow patient responses to treatment. In parts of the world where access to medical care is limited, it might also be used for diagnostic purposes where endoscopy with biopsy is not available."
This study is funded by National Institute of Allergy and Infectious Diseases as well as from the American Gastroenterological Association (AGA) and the CURED Foundation (Campaign Urging Research for Eosinophilic Diseases). CURED has given the researchers an unlimited amount for research on this disease as well as other related gastrointestinal diseases.
"These grants present us with an exciting opportunity to increase our understanding of this difficult, newly-emerging disease, which has increased in detection, and also possibly in incidence."
The likelihood that doctors will actually employ this new procedure will "ultimately depend on how easy it is to perform in children, how cost-effective it is, and whether the specific tests for eosinophil products performed on the string become commercially available through diagnostic testing services," said Ackerman.
More information about this disease can be found at apfed.org.
is a member of the 
Be the first to comment on this article!