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Volume 155, Issue 4, Pages e10 (October 2018)

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Presentation on theme: "Volume 155, Issue 4, Pages e10 (October 2018)"— Presentation transcript:

1 Volume 155, Issue 4, Pages 1022-1033.e10 (October 2018)
Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference  Evan S. Dellon, Chris A. Liacouras, Javier Molina-Infante, Glenn T. Furuta, Jonathan M. Spergel, Noam Zevit, Stuart J. Spechler, Stephen E. Attwood, Alex Straumann, Seema S. Aceves, Jeffrey A. Alexander, Dan Atkins, Nicoleta C. Arva, Carine Blanchard, Peter A. Bonis, Wendy M. Book, Kelley E. Capocelli, Mirna Chehade, Edaire Cheng, Margaret H. Collins, Carla M. Davis, Jorge A. Dias, Carlo Di Lorenzo, Ranjan Dohil, Christophe Dupont, Gary W. Falk, Cristina T. Ferreira, Adam Fox, Nirmala P. Gonsalves, Sandeep K. Gupta, David A. Katzka, Yoshikazu Kinoshita, Calies Menard-Katcher, Ellyn Kodroff, David C. Metz, Stephan Miehlke, Amanda B. Muir, Vincent A. Mukkada, Simon Murch, Samuel Nurko, Yoshikazu Ohtsuka, Rok Orel, Alexandra Papadopoulou, Kathryn A. Peterson, Hamish Philpott, Philip E. Putnam, Joel E. Richter, Rachel Rosen, Marc E. Rothenberg, Alain Schoepfer, Melissa M. Scott, Neil Shah, Javed Sheikh, Rhonda F. Souza, Mary J. Strobel, Nicholas J. Talley, Michael F. Vaezi, Yvan Vandenplas, Mario C. Vieira, Marjorie M. Walker, Joshua B. Wechsler, Barry K. Wershil, Ting Wen, Guang-Yu Yang, Ikuo Hirano, Albert J. Bredenoord  Gastroenterology  Volume 155, Issue 4, Pages e10 (October 2018) DOI: /j.gastro Copyright © 2018 AGA Institute Terms and Conditions

2 Figure 1 Updated EoE diagnostic algorithm.
Gastroenterology  , e10DOI: ( /j.gastro ) Copyright © 2018 AGA Institute Terms and Conditions

3 Supplementary Figure 1 Summary of histologic and clinical response rates for PPI treatment of esophageal eosinophilia in studies with >5 subjects reported. (A) Studies in children. (B) Studies in adolescents/adults. Gastroenterology  , e10DOI: ( /j.gastro ) Copyright © 2018 AGA Institute Terms and Conditions

4 Supplementary Figure 2 Anti-inflammatory effects of PPIs: PPIs may decrease esophageal eosinophilia in EoE. Different properties of PPI may explained the anti-inflammatory effect of PPI observed in PPI-RE patients: 1) PPIs can inhibit inflammatory functions such as oxidative burst, cell migration, and phagocytosis. PPIs also inhibit the expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 recognized by ligands on the eosinophil cell surface. 2) Sulfenamides are the acid activated compounds derived from PPI. They inhibit parietal cell H+-K+ATPases (proton pumps) also expressed by inflammatory cells (including eosinophils). 3) Acidic milieu has been shown to increase eotaxin-3 release from esophageal epithelial cells. 4) PPI blocked IL-13 and IL-4 stimulated increase in eotaxin-3 mRNA expression and protein secretion through the signal transducer and activator of transcription 6 and RNA polymerase II binding to the eotaxin-3 promoter. 5) PPIs might reduce esophageal eosinophilia by restoring esophageal mucosal barrier integrity characterized in part by dilated intercellular spaces (DIS) which render the esophageal mucosa permeable to swallowed antigens linked to the Th2 response. Gastroenterology  , e10DOI: ( /j.gastro ) Copyright © 2018 AGA Institute Terms and Conditions

5 Supplementary Figure 3 Proposed Mechanism of PPI inhibition of Th2-cytokine-stimulated eotaxin-3 expression. Th2 cytokine, IL-13 (or IL-4), can stimulate eotaxin-3 expression via signal transducer and activator of transcription 6 (STAT6) signaling in esophageal epithelial cells. However, in the presence of a PPI such as omeprazole, binding of both STAT6 and RNA polymerase II (RNA Pol II) to the eotaxin-3 promoter is decreased, and transcription of eotaxin-3 mRNA is reduced. Gastroenterology  , e10DOI: ( /j.gastro ) Copyright © 2018 AGA Institute Terms and Conditions


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