Food Antigen in Eosinophilic Esophagitis

One of the putative mechanisms of eosinophilic esophagitis is exposure of food antigens to
antigen recognition cells in the esophageal mucosa that initiates a chronic allergy-based
inflammatory response . It is believed that this exposure is facilitated through dilation of
the intercellular spaces (DIS) between esophageal epithelial cells (termed spongiosis). This
is substantiated by several studies which have demonstrated that: first, DIS is commonly
found in biopsies from patients with active EoE and reverses with steroid therapy; second,
DIS correlates to physiologic demonstration of increased esophageal epithelial permeability
as shown through transepithelial small molecule flux in mucosal biopsies appraised in Ussing
chambers and increased conductivity of electric current as measured in a mucosal impedance
probe (Katzka, et al., in press, Clin Gastroenterol Hepatol). Although these mechanisms make
intuitive sense, no one has shown the presence of food antigen in esophageal mucosa after
ingestion and the correlation of this presence to dilation of intercellular spaces.

Inclusion criteria:

- Patients between the ages of 18 and 80 with eosinophilic esophagitis diagnosed by a
combination of compatible symptoms, endoscopic findings, histology, and lack of
response to proton pump inhibitors.

- Patients previously diagnosed with Eosinophilic Esophagitis and are now in histologic
remission due to treatment and have <15 eos hpf.

Exclusion Criteria

- Acute allergy to wheat or soy

- Currently taking steroids

- Inability to read due to: Blindness, cognitive dysfunction, or English language
illiteracy