PD03.09. Modulation of Eosinophil-Related Biomarkers by Proton Pump Inhibitors in Eosinophilic Esophagitis

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ID: 325948
2026
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Ranked #190 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Eosinophilic Esophagitis Background Eosinophilic esophagitis (EoE) is a chronic allergic inflammation causing eosinophil buildup in the esophagus, leading to dysphagia and food impactions. Treatment is assessed by invasive biopsies. This study investigates blood-based eosinophil markers before and after proton pump inhibitor therapy to find noninvasive biomarkers for disease monitoring. Methods Seventeen adults with EoE provided blood samples, esophageal biopsies, and symptom assessments using the Watson Dysphagia Scale (WDS) and Eosinophilic Esophagitis Activity Index (EEsaI) before and after 12 weeks of proton pump inhibitor treatment (omeprazole 20 mg twice daily). Biopsies were evaluated for eosinophils per high-power field (eosinophils/HPF) and with the Eosinophilic Esophagitis Histologic Scoring System (EoE-HSS). Blood samples from 17 healthy controls were included. Endoscopic findings were scored using the Eosinophilic Esophagitis Endoscopic Reference Score (EREFS). To characterize eosinophil subpopulations, we designed an antibody panel for eosinophil markers and analyzed samples by mass cytometry (CyTOF), using FlowSOM and Opt-SNE for clustering and visualization. Results Twelve patients responded to proton pump inhibitor treatment and achieved fewer than 15 peak eosinophils per high-power field, while five did not respond. In the responder group, eosinophils/HPF decreased from a mean of 45 (range 16–108) before treatment to 2 (range 0–9) after treatment. Scores from the EoE-HSS also improved, with grade scores falling from 0.6 to 0.2 and stage scores from 0.8 to 0.4. FlowSOM analysis identified ten distinct eosinophil clusters, of which two decreased significantly following treatment; these were characterized by galectin-10–positive and CD16-positive eosinophils. Opt-SNE visualization further showed that FOXP3-expressing populations expanded after treatment, a pattern not observed in nonresponders. Clinically, most patients reported reduced symptom burden after treatment, as reflected by improvements in WDS scores (mean 18 to 14) and EEsaI scores (mean 45 to 31). Endoscopic findings also improved, with EREFS values decreasing from a mean of 3.0 to 1.9. Conclusion Proton pump inhibitor treatment significantly reduced eosinophil counts and improved histologic, endoscopic, and symptom scores in responders. Distinct eosinophil subpopulations changed notably post-treatment, highlighting potential biomarkers. Blood-based immune profiling may offer a noninvasive method to monitor treatment response in eosinophilic esophagitis.
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Authors Christine Lingblom, John Plate, Helen Larsson
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.095
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.095/70761208/doag077.095.pdf
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