P0306 - Patients With Eosinophilic Esophagitis and Gastrointestinal Symptoms May Have Eosinophilic Gastritis and/or Duodenitis, Not Associated With Peak Esophageal Eosinophil Count

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Kathryn Peterson, MD, MSCI

University of Utah School of Medicine
Salt Lake City, UT, United States

Kathryn Peterson, MD, MSCI¹, Robert M. Genta, MD, FACG², Henrik Rasmussen, MD, PhD³, Bradford A. Youngblood, PhD³, Amol P. Kamboj, MD³
¹University of Utah School of Medicine, Salt Lake City, UT; ²Inform Diagnostics, Irving, TX; ³Allakos, Inc., Redwood City, CA

Introduction: Many patients with eosinophilic esophagitis (EoE) present with extra-esophageal or atypical symptoms. We previously evaluated gastric and duodenal biopsies from patients with EoE with and without persistent extra-esophageal gastrointestinal (GI) symptoms to determine if they had eosinophilic gastritis and/or duodenitis (EG and/or EoD)¹. In this study, we investigated correlations between peak esophageal eosinophil counts and concomitant EG and/or EoD.

Methods: We studied 45 patients with EoE and GI symptoms (abdominal pain, nausea, bloating) and/or a previous diagnosis of irritable bowel syndrome (EoE+S) and 12 patients with EoE without extra-esophageal symptoms (EoE–S). All had initial gastric and duodenal biopsies interpreted as non-specific inflammation or normal. Gastric and duodenal eosinophils were systematically counted in biopsies by a blinded GI pathologist; EG and EoD were defined as ≥30 eosinophils/high-power field (hpf) in ≥5 hpfs in gastric and ≥3 hpfs in duodenal specimens, respectively.

Results: Thirty-one of the 45 EoE+S patients (69%) met histologic criteria for EG and/or EoD: 8 (18%) met histologic criteria for EG and 23 (51%) met histologic criteria for EoD. None of the EoE–S patients met histologic criteria for EG and 3 met histologic criteria for EoD. Peak esophageal eosinophil counts did not differ significantly between patients with EoE+S vs EoE–S, and were not associated with the presence of EG or EoD (Figure).

Discussion: Sixty-nine percent of patients with EoE and extra-esophageal GI symptoms met the histologic criteria for EG and/or EoD. Peak esophageal eosinophil counts were not associated with the presence of EG or EoD and therefore should not be used to guide gastroduodenal biopsy. Patients with EoE and persistent extra-esophageal GI symptoms, regardless of peak esophageal eosinophil counts, should undergo systematic collection and histologic analysis of gastric and duodenal biopsies to identify those with concomitant EG and/or EoD.

Reference:
1. Peterson KA, Genta RM, Rasmussen HS, et al. Fr178: Gastroduodenal Eosinophilia Is Under-Appreciated in Eosinophilic Esophagitis (EoE) Patients With Functional Bowel Symptoms: A Real Life Experience.Gastroenterology.2021 May;160(6): Supplement:S262.

Figure: Figure: Peak Esophageal Eosinophil Counts in Patients With EoE, With vs Without GI Symptoms
EoE+S EG: patients with EoE and extra-esophageal GI symptoms who met criteria for EG (≥30 eos in ≥5 gastric hpfs)
EoE+S EoD: patients with EoE and extra-esophageal GI symptoms who met criteria for EoD (≥30 eos in ≥3 duodenal hpf)
EoE–S: patients with EoE without extra-esophageal GI symptoms
Dotted line indicates histologic threshold for EG and/or EoD
Caps indicate minimum and maximum; box, 25th and 75th percentile; center line, median
P value from unpaired t test of simple 1-way ANOVA, compared with EoE-S
Note: Some patients were receiving treatment for EoE at the time of esophageal biopsy collection

Disclosures:

Kathryn Peterson: Allakos – Grant/Research Support. Astra Zeneca – Grant/Research Support. AstraZeneca – Advisory Committee/Board Member. Choban – Grant/Research Support. Chobani – Grant/Research Support. Eli Lily – Advisory Committee/Board Member. Ellodi – Grant/Research Support. Medscape – Advisory Committee/Board Member. Nexeos – Stockholder/Ownership Interest (excluding diversified mutual funds), Other Financial or Material Support, Equity. NIH – Grant/Research Support. Regeneron-Sanofi – Grant/Research Support. Regeneron-Sanofi – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member.

Robert Genta: Adare/Ellodi – Consultant. Allakos – Consultant. Inform Diagnostics – Employee. Red Hill Pharmaceuticals – Consultant.

Henrik Rasmussen: Allakos, Inc – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds).

Bradford Youngblood: Allakos – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Amol Kamboj: Allakos – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Kathryn Peterson, MD, MSCI¹, Robert M. Genta, MD, FACG², Henrik Rasmussen, MD, PhD³, Bradford A. Youngblood, PhD³, Amol P. Kamboj, MD³. P0306 - Patients With Eosinophilic Esophagitis and Gastrointestinal Symptoms May Have Eosinophilic Gastritis and/or Duodenitis, Not Associated With Peak Esophageal Eosinophil Count, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.