Assessment of Fractionated Exhaled Nitric Oxide as a Biomarker for the Treatment of Eosinophilic Esophagitis

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Assessment of Fractionated Exhaled Nitric Oxide as a Biomarker for the Treatment of Eosinophilic Esophagitis

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Title: Assessment of Fractionated Exhaled Nitric Oxide as a Biomarker for the Treatment of Eosinophilic Esophagitis
Author: Leung, John; Nguyen-Traxler, Ann; Lee, Erika M.; Yip, Jason S.; Weinstock, Joel V.; Chan, Walter Wai-Yip; Ngo, Peter; Weinstein, Barbara J.; Bonis, Peter A.

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Citation: Leung, John, Ann Nguyen-Traxler, Erika M. Lee, Jason S. Yip, Joel V. Weinstock, Walter Wai-Yip Chan, Peter Ngo, Barbara J. Weinstein, and Peter A. Bonis. 2012. Assessment of fractionated exhaled nitric oxide as a biomarker for the treatment of eosinophilic esophagitis. Allergy and Asthma Proceedings 33(6): 519-524.
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Abstract: Diagnosis of eosinophilic esophagitis (EoE) and determination of response to therapy is based on histological assessment of the esophagus, which requires upper endoscopy. In children, in whom a dietary approach is commonly used, multiple endoscopies are needed, because foods are eliminated and then gradually reintroduced. Ideally, noninvasive methods could supplement or replace upper endoscopy to facilitate management. Fractionated exhaled nitric oxide (FeNO) has been proposed as a useful measure for monitoring disease activity in studies of patients with eosinophil-predominant asthma and in other atopic disorders. Thus, we evaluated whether FeNO levels could be a useful biomarker to assess the response to therapy in EoE patients. This study was designed to determine whether there is a change in FeNO levels during treatment with topical corticosteroids and whether changes correlated with clinical response. This was a prospective, multicenter study that enrolled nonasthmatic patients with established EoE. FeNO levels and symptom scores were measured at baseline, biweekly during 6-week swallowed fluticasone treatment, and 4 weeks posttreatment. Twelve patients completed the trial. We found a statistically significant difference between median pre- and posttreatment FeNO levels [20.3 ppb (16.0–29.0 ppb) vs 17.6 ppb (11.7–27.3 ppb), p=0.009]. However, neither the pretreatment FeNO level, a change of FeNO level after 2 weeks of treatment, nor the FeNO level at the end of treatment confidently predicted a clinical or histological response. Although our findings suggest nitric oxide possibly has a physiological role in EoE, our observations do not support a role of FeNo determination for management of EoE.
Published Version: doi:10.2500/aap.2012.33.3606
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522397/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:11181113
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