SYSTEMATIC REVIEW article
Front. Med.
Sec. Gastroenterology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1607306
This article is part of the Research TopicUpdate on Eosinophil-associated diseasesView all 5 articles
Non-invasive biomarkers to diagnose and monitor Eosinophilic Esophagitis: A systematic review
Provisionally accepted
- 1Malaghan Institute of Medical Research, Faculty of Science, Victoria University of Wellington, Wellington, Wellington, New Zealand
- 2University of Otago, Wellington, Newtown, Wellington, New Zealand
- 3Hutt Hospital, Lower Hutt, New Zealand
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Current assessments for diagnosing and monitoring eosinophilic esophagitis (EoE) are invasive, time-intensive and costly. The development of non-invasive biomarkers that are sensitive and specific for EoE is paramount. We aimed to provide a comprehensive update on the latest biomarker discovery research in EoE and discuss the current state of the field.PubMed, Web of Science, Medline and Embase were searched for studies on non-invasive biomarkers for EoE. Extracted studies were analyzed for risk of bias and relevant data was extracted, including study design, participants, information on controls, biomarker detection method, biomarkers studied, and biomarkers for which statistical significance was found.Of the 239 studies identified, 37 articles met the inclusion criteria and were included in the systematic review. Across these studies, over 80 biomarkers were evaluated as potential noninvasive tools for diagnosing and monitoring EoE. While the most commonly investigated biomarker was peripheral eosinophil count (PEC), overall PEC demonstrated limited reliability. Other emerging biomarkers, including eosinophil-derived proteins (e.g. EDN, MBP-1) and cytokines (e.g. eotaxin-3), showed promise, although findings were inconsistent between studies. Esophageal-specific sampling methods, such as the Cytosponge, esophageal string test (EST), and esophageal brushings, demonstrated strong correlations with histologic eosinophil counts and disease activity, particularly through the measurement of eosinophilassociated proteins.Esophageal-specific sampling methods show significant promise for accurately diagnosing and monitoring EoE, particularly through eosinophil-derived biomarkers, such as eosinophil-derived neurotoxin (EDN). Furthermore, these methods were better tolerated and more costeffective compared to endoscopy and biopsy.
Keywords: Eosinophilic Esophagitis, non-invasive biomarkers, biomarkers, diagnosis, disease monitoring
Received: 14 Apr 2025; Accepted: 16 Jun 2025.
Copyright: © 2025 Noble, Tyrrell, Mules and Inns. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Richard Tyrrell, University of Otago, Wellington, Newtown, 6021, Wellington, New Zealand
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