Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 13 February 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Eosinophilic esophagitis is associated with IgG4 and not mediated by IgE

This month's Gastroenterology evaluates the roles of IgE and IgG4 in the development of eosinophilic esophagitis.

News image

Eosinophilic esophagitis is usually triggered by foods, by unclear mechanisms.

Dr Frederic Clayton and colleagues from Utah, USA evaluated the roles of IgE and IgG4 in the development of eosinophilic esophagitis.

The research team performed a prospective, randomized, double-blind, placebo-controlled trial of adults with eosinophilic esophagitis given an antibody against IgE or placebo every 2–4 weeks for 16 weeks, based on weight and serum level of IgE.

Endoscopy was performed, esophageal biopsy specimens were collected, and symptoms were assessed at baseline and at 16 weeks.

Maximum numbers of eosinophils/high-power field were determined.

Granular extracellular IgG4 was detected in biopsy specimens from 21 of 24 patients
Gastroenterology

Homogenates of esophageal biopsy specimens from 11 subjects with eosinophilic esophagitis and 8 without were assessed for IgM, IgA, and IgG subclasses.

In a retrospective analysis, the researchers performed immunofluorescence analysis of IgG4 in fixed esophageal tissues from 2 patients with eosinophilic esophagitis who underwent esophagectomy, and 47 consecutive autopsies.

The researchers also performed immunofluorescence analysis of IgG4 in esophageal mucosal biopsy specimens from 24 subjects with eosinophilic esophagitis, and 9 without.

Finally, sera were collected from 15 subjects with eosinophilic esophagitis and from 41 without (controls), and assayed for total and food-reactive IgG4.

The research team found that omalizumab did not alter symptoms of eosinophilic esophagitis or eosinophil counts in biopsy samples compared with placebo.

Homogenates of esophageal tissues from patients with eosinophilic esophagitis had a 45-fold increase in IgG4 compared with controls, but no significant increases in other IgG subclasses, IgM, or IgA.

Sparse stromal deposits resembling immune complexes were found in 2 of 5 eosinophilic esophagitis biopsy specimens based on ultrastructural analysis.

The team found that esophagectomy samples from 2 patients with eosinophilic esophagitis contained 180 and 300 IgG4 plasma cells/maximal high-power field, mainly in the deep lamina propria; these levels were greater than in tissues from controls.

Fibrosis essentially was exclusive to the lamina propria.

Granular extracellular IgG4 was detected in biopsy specimens from 21 of 24 patients with eosinophilic esophagitis, but in none of the specimens from 9 controls.

The researchers found that total serum level of IgG4 increased only slightly in patients with eosinophilic esophagitis, compared with controls.

Subjects with eosinophilic esophagitis had increased serum levels of IgG4 that reacted with milk, wheat, egg, and nuts—the 4 foods that most commonly trigger this condition.

Dr Clayton's team concludes, "In a prospective trial, omalizumab did not reduce symptoms of eosinophilic esophagitis or tissue eosinophil counts compared with placebo."

"This finding, along with observed granular deposits of IgG4, abundant IgG4-containing plasma cells, and serum levels of IgG4 reactive to specific foods, indicate that, in adults, eosinophilic esophagitis is IgG4-associated, and not an IgE-induced allergy."

Gastroenterol 2014: 147(3): 602–609
02 September 2014

Go to top of page Email this page Email this page to a colleague

 12 February 2016 
Colorectal cancer after negative signoidoscopy
 12 February 2016 
Genetic factors and response to glucocorticoids in IBD
 12 February 2016 
Tobacco smoking and the natural history of Crohn’s
 11 February 2016 
Colorectal surgery training
 11 February 2016 
Liver disease unique to pregnancy
 11 February 2016 
Serous cystic neoplasm 
 10 February 2016 
NAFLD in Veterans in the USA
 10 February 2016 
Rectosigmoidoscopy vs colonoscopy in ulcerative colitis
 10 February 2016 
Liver cancer and primary biliary cirrhosis
 09 February 2016 
Bowel preparation for colonoscopy screening
 09 February 2016 
Eosinophilic esophagitis and parental allergies
 09 February 2016 
Cancer-specific prognosis in octogenarians with colorectal cancer
 08 February 2016 
Cancelled colonoscopy appointments
 08 February 2016 
Cognitive function in Crohn's disease
 08 February 2016 
Immunity in the human gut
 05 February 2016 
Treatment for ileal pouch-anal anastomosis for Crohn’s colitis
 05 February 2016 
Helicobacter cinaedi bacteremia
 05 February 2016 
Methotrexate and remission in ulcerative colitis
 04 February 2016 
Diabetes and liver cancer
 04 February 2016 
Colorectal cancer screening
 04 February 2016 
H. pylori and coronary heart disease 
 03 February 2016 
Acute diverticulitis and IBS 
 03 February 2016 
Microbiota of the colonic mucosa and chronic constipation
 03 February 2016 
Guidelines for chronic pancreatitis
 02 February 2016 
Ramosetron and IBS-diarrhea
 02 February 2016 
IBD emergency department visits
 02 February 2016 
Probiotics for H. pylori management
 01 February 2016 
Managing HBV in pregnancy
 01 February 2016 
Depressive symptoms in IBD 
 01 February 2016 
Obesity and hepatocellular carcinoma risk
 29 January 2016 
Colorectal cancer after colonoscopy
 29 January 2016 
Acute diverticulitis in immunosuppressed patients
 29 January 2016 
Vitamin D and colorectal cancer risk
 28 January 2016 
Tissue anti-TNF drug levels and IBD
 28 January 2016 
First line treatment of H. pylori infection
 28 January 2016 
Tetracycline for rosacea increases the risk of IBD
 27 January 2016 
Steroids in children with Crohn's
 27 January 2016 
Self-management IBS program 
 27 January 2016 
Human gut microbiome in IBD 
 26 January 2016 
Smoking and symptomatic diverticular disease
 26 January 2016 
Step-down therapy in PPI-responsive esophageal eosinophilia 
 26 January 2016 
Diet and IBD risk
 25 January 2016 
IBD monitoring using smartphones
 25 January 2016 
Self-management IBS program
 25 January 2016 
Colorectal cancer after a negative screening sigmoidoscopy
 22 January 2016 
Length of Barrett's and cancer
 22 January 2016 
Psychosocial interventions and alcohol abstinence in chronic liver disease
 22 January 2016 
Helicobacter pylori antibiotic resistance
 21 January 2016 
Increasing adenoma detection rate during colonoscope withdrawal
 21 January 2016 
Microscopic colitis current concepts
 21 January 2016 
Statins as a management strategy for constipation 
 20 January 2016 
Health status after bariatric surgery
 20 January 2016 
Hep E infection in West Africa
 20 January 2016 
Preventing endoscopic bacterial transmission
 19 January 2016 
PPIs and phlebotomy in hereditary hemochromatosis
 19 January 2016 
Predicting liver cirrhosis in Hep C
 19 January 2016 
Frozen vs fresh fecal microbiota transplantation
 18 January 2016 
Hospitalization for diverticulitis in the USA
 18 January 2016 
H. pylori and gastric cancer across Europe
 18 January 2016 
Enteral nutrition in children with Crohn's

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us