Comparison of eotaxin-3 biomarker in patients with eosinophilic oesophagitis, proton pump inhibitor-responsive oesophageal eosinophilia and gastro-oesophageal reflux disease

Aliment Pharmacol Ther. 2015 Jul;42(2):231-8. doi: 10.1111/apt.13258. Epub 2015 May 24.


Background: Proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE) is a recently described entity which resembles oeosinophilic oesophagitis (EoE), yet responds to acid suppressive treatment.

Aim: To determine whether EoE shares similar staining features with PPI-REE or with gastro-oesophageal reflux disease (GERD).

Methods: This retrospective study consisted of patients with an established diagnosis of EoE, PPI-REE, or GERD identified from a database during a 1-year period. Immunohistochemistry (IHC) analysis was performed specifically targeting eotaxin-3 antibodies. All sections were qualitatively (intensity) and quantitatively (percentage of cells stained) assessed independently by two blinded pathologists.

Results: The cohort consisted of three groups of patients: EoE (n = 22), PPI-REE (n = 23) and GERD (n = 23) for a total of 68 patients. Study demographics included mean age 39 (14) years, 75% male and 77% Caucasian. There was a significant difference in the eotaxin-3 staining among EoE, PPI-REE and GERD groups [mean score (s.d.): 1.2 (1.2), 0.8 (1.0), 0.3 (0.7), P = 0.006]. Staining scores of EoE patients were significantly higher compared with GERD (P = 0.002) and a trend towards significance was seen between EoE and PPI-REE (P = 0.054). There was also a significant difference in EoE staining intensity score among the three groups (P = 0.006). Intensity scores of EoE were significantly higher compared with GERD [1.0 (0.9) vs. 0.22 (0.52), P < 0.001]. There was no significant difference between EoE and PPI-REE groups [1.0 (0.0) vs. 0.52 (0.75) P = 0.094].

Conclusions: A difference in eotaxin-3 staining was seen in the three groups of patients with oesophageal eosinophilia. Eotaxin-3 can distinguish EoE from GERD, but not from proton pump inhibitor responsive-oesophageal eosinophilia.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Biomarkers
  • Chemokine CCL26
  • Chemokines, CC / immunology*
  • Diagnosis, Differential
  • Eosinophilic Esophagitis / diagnosis*
  • Eosinophilic Esophagitis / drug therapy
  • Eosinophilic Esophagitis / pathology*
  • Female
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / pathology*
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Proton Pump Inhibitors / therapeutic use
  • Retrospective Studies


  • Biomarkers
  • CCL26 protein, human
  • Chemokine CCL26
  • Chemokines, CC
  • Proton Pump Inhibitors