BIOGRAPHICAL SKETCH
Provide the following information for the applicant.
NAME
Current Class Year
1
2
3
First:
Kevin
M Initial: Z
Last:
Huang
4
EDUCATION/TRAINING (Indicate all regular academic and professional education starting with college)
INSTITUTION AND LOCATION
DEGREE
YEAR(s)
FIELD OF STUDY
Institution: Emory University
Location: Atlanta, GA
BS
From: 08/10
To: 05/14
Biology
Institution: University of North Carolina at Chapel Hill
Location: Chapel Hill, NC
MD
From: 08/14
To:
MD anticipated
Institution:
Location:
From:
To:
A. Honors, Awards, Extracurricular Activities, and Community Service
(2014 - Present) Student Health Action Coalition (SHAC): Beyond Clinic Walls Volunteer, Clinic Public Health Educator, Medical
Team Junior Volunteer, Medical Team Junior Coordinator; Chapel Hill NC
(2014 - Present) UNC School of Medicine: Internal Medicine Interest Group Leader, Integrative Medicine Interest Group Leader,
Multidisciplinary Care Interest Group Leader, Chapel Hill NC
(January 2013 - August 2013) Emory Clinic Gastroenterology Department, Volunteer, Atlanta GA
(January 2012 - August 2013) Children's Hospital of Altlanta, Volunteer, Atlanta GA
B. Employment Experience
(August 2011 - May 2013) Biology, Cell Biology, and Biochemistry Teaching Assistant, Emory University Biology Department, Atlanta
GA
(August 2011 - May 2014) Emory Pathways for Academic Success for Students (EPASS) Biology Peer Tutor, Atlanta GA
(May 2013 - May 2014) EPASS Captain (Administrator), Atlanta GA
C. Previous Research Experience
(May 2013 - August 2013) Summer Research Intern, Carolina BioOncology Institute, Huntersville NC
I worked on a research project exploring the clinical uses of oncolytic viruses.
(May 2012 - June 2013) Research Assistant with Dr. Madeleine Hackney
This project investigated the effects of adapted tango on patients with Parkinson's disease and vision impairments. Patient's were enrolled
in the 12-week program, and motor, cognitive, and psychosocial measures were obtained before, during, and after the program.
D. Theses, Publications and Presentations
None
E. Professional Societies
American Medical Student Association
Phi Beta Kappa Honor Society
Phi Sigma Biological Sciences Honor Society
Alpha Epsilon Delta Health Preprofessional Honor Society
Phi Eta Sigma National Honor Society
THE UNIVERSITY
of NORTH CAROLINA
at CHAPEL HILL
EVAN S. DELLON, MD, MPH
Associate Professor of Medicine
Division of Gastroenterology and Hepatology
T 919.966.9757
F 919.843.2508
edellon@med.unc.edu
4140 BIOINFORMATICS BUILDING
CAMPUS BOX 7080
CHAPEL HILL, NC 27599-7080
To:
Office of Medical Student Research
UNC School of Medicine
Re:
Summer medical student research application for Kevin Huang
January 26, 2015
Dear colleagues,
It is my pleasure to write this letter supporting Kevin Huang’s application for the Carolina Medical
Student Research Program. I have met with him on multiple occasions, have helped him develop his
application, and I feel that he is an excellent candidate for this program.
Kevin was first introduced to biomedical research during his college years, and has had experiences both
in the lab (with oncolytic viruses) and in a clinical setting (evaluating and rehabilitating patients with
Parkinson’s). He also excelled academically, being elected to national honors societies in both the
humanities and sciences. These early research experiences, now coupled with his first year medical
school curriculum, have strongly interested him in exploring clinical and epidemiologic research.
For the CMSRP, we have designed a focused research project on eosinophilic esophagitis (EoE) that
will give him this introduction to clinical and epidemiologic research. EoE is a newly recognized disease
about which much is yet unknown, including the growth outcomes in children treated with different
modalities. Specifically, this project aims to determine whether treatment type (topical steroids, dietary
elimination, or elemental formula) is associated improved growth outcomes, both in patients being
treated the first time and in treatment-refractory patients. This project is circumscribed and feasible in
the limited time frame, as data collection and analysis will utilize an existing and previously identified
patient population. Specifically, it will use the Carolinas EoE Collaborative (CEoEC), a multicenter
network of EoE providers (gastroenterologists, allergist, and dieticians). I am a co-founder of the
CEoEC, and a close collaborator with the other co-founders at the non-UNC sites (Asthma and Allergy
Specialists in Charlotte, NC; and Pediatric GI in the Greenville, SC, Health System).
I will be mentoring Kevin closely on this project. We will meet at minimum on a weekly basis and I
expect he will learn not only a substantial amount of background information about EoE, but also key
tenants of epidemiologic study design and statistical analysis. I will provide appropriate education about
these topics, as well as the financial resources to conduct the data collection and analysis. Kevin is a
primary author of, and has been actively involved in, the research design process. My expectation is that
with my assistance he will draft and submit the IRB application, identify patients from the three sites
and extract data using standard case report forms, create and manage a database, participate in data
analysis, interpret the data, present the findings, and draft a manuscript. In short, he will have ownership
of this project.
I am excited to participate as a mentor in this project and to work with Kevin. I think his selfmotivation, organization, and inquisitiveness that I have already observed, as well as a keen interest in
obtaining more exposure to clinical research, makes me confident that he will successfully complete this
project. Moreover, I should also note that of his own volition, this past winter he has started to assist me
on a separate research project related to EoE, and he will be a co-author on that paper as well in the
coming months. In addition, I have worked with a number of medical students at UNC, including those
who have participated in the CMSRP, and have successfully mentored them on projects that have been
published. Kevin is a great fit for the CMSRP, and he has my strongest recommendation for being
accepted.
Please do not hesitate to contact me with any questions.
Sincerely,
Evan S. Dellon, MD MPH
Associate Professor of Medicine
Division of Gastroenterology and Hepatology
University of North Carolina School of Medicine
BIOGRAPHICAL SKETCH
Provide the following information for the Senior/key personnel and other significant contributors.
Follow this format for each person. DO NOT EXCEED FOUR PAGES.
NAME
POSITION TITLE
Dellon, Evan Samuel
Associate Professor of Medicine
Adjunct Associate Professor of Epidemiology
eRA COMMONS USER NAME (credential, e.g., agency login)
edellon
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training and
residency training if applicable.)
DEGREE
INSTITUTION AND LOCATION
MM/YY
FIELD OF STUDY
(if applicable)
Brown University, Providence RI
Johns Hopkins School of Medicine,
Baltimore, MD
Massachusetts General Hospital (MGH),
Boston, MA – Intern and resident
University of North Carolina (UNC) School of
Medicine, Department of Medicine,
Chapel Hill, NC – Clinical fellow
UNC School of Medicine, Department of
Medicine, Chapel Hill, NC – Research fellow
UNC School of Public Health,
Chapel Hill, NC
AB
5/95
Health & Society; Music
MD
5/99
Medicine
--
1999-2002
Internal Medicine
--
2004-2006
Gastroenterology
--
2006-2008
Gastroenterology
MPH
12/07
Epidemiology
A. Personal Statement
I am an academic gastroenterologist with formal research training in epidemiology, clinical research, and
clinical trial design. My goal as a physician-scientist is to lead and collaborate with a multidisciplinary research
team in the area of esophageal diseases, and eosinophilic esophagitis (EoE) in particular. My current research
focuses on optimizing the diagnosis, characterizing the epidemiology, studying the pathogenesis, and refining
the treatment and management of EoE, with the overall goal of improving patient care and outcomes in EoE. I
have published over 50 manuscripts and 65 abstracts specifically related to EoE. I am also actively involved in
mentoring and advising medical students (including those in the CMSPR program), residents, and postdoctoral fellows in research projects, and this work has also yielded multiple publications. Through my NIHsupported research (KL2, K23, R01), I have established a number of patient cohorts, including the UNC EoE
Clinicopathologic Database and the UNC EoE Patient Registry and Specimen Biobank, as well as co-founded
the Carolinas EoE Collaborative (CEoEC). This latter resource, a pre-existing multi-site network with existing
patient registries, will be utilized for the proposed project. Given my research experience in EoE, my
background in clinical, epidemiologic, and translational research techniques, and my ongoing role in mentoring,
I am well-suited to be the mentor for this summer research project (please see my letter for full details).
B. Positions and Honors
Positions and Employment
2002-2004
Hospitalist, Medical Access Unit, Department of Medicine, MGH, Boston, MA
2002-2004
Assistant in Medicine, Department of Medicine, MGH, Boston, MA
2002-2004
Instructor, Harvard Medical School, Boston, MA
2002-2004
In-house physician, Emerson Hospital, Concord, MA
2004
Assistant Director, Medical Access Unit, Department of Medicine, MGHl, Boston, MA
2007-2008
Clinical Instructor, Department of Medicine, UNC, Chapel Hill, NC
2008-2013
Assistant Professor of Medicine, Division of Gastroenterology, UNC, Chapel Hill, NC
2009-2013
Adjunct Asst. Prof. of Epidemiology, UNC School of Public Health, Chapel Hill, NC
2013-present Associate Professor of Medicine, Division of Gastroenterology, UNC, Chapel Hill, NC
2013-present Adjunct Assoc. Prof. of Epidemiology, UNC School of Public Health, Chapel Hill, NC
Board Certifications, Professional Memberships, and Other Experience
1997-2000
1999-2004
2002-present
2004-present
2004-present
2004-present
2005-present
2007-present
2007-present
2009-present
United States Medical Licensing Exam, completed steps 1-3
Massachusetts Board of Registration in Medicine, licensee
American Board of Internal Medicine, Diplomate in Internal Medicine, 2002
North Carolina Medical Board, licensee
Member, American Gastroenterological Association
Member, American Society for Gastrointestinal Endoscopy
Member, American College of Gastroenterology
Member, North Carolina Society of Gastroenterology
American Board of Internal Medicine, Diplomate in Gastroenterology, 2007
Associate Editor, Digital Atlas of Video Education (http://daveproject.org)
Selected Honors
1990 Cricklair Award for best non-M.D. presentation at the Plastic Surgery Research Council meeting
1994 Phi Beta Kappa
1999 Alpha Omega Alpha
1999 Warfield T. Longcope Prize for excellence by a medical student entering the field of Internal Medicine
2005 ACG Travel Award for a top presentation at the 2005 ACG National Fellow’s Forum in Boston
2006 UNC-Wessex Exchange, selected to participate in a GI-fellow exchange to Wessex, England
2008 NC Society of Gastroenterology Clinical Vignette Award
2008 AstraZeneca Emerging Leaders, selected to participate in international program
2008 America College of Gastroenterology (ACG), Junior Faculty Development Award
2008 UNC Clinical Translation Science Award / KL2 Scholars Program participant
2008 ACG/AstraZeneca Senior Fellow Award for a top abstract submitted to the 2008 ACG meeting
2009 UNC Teaching Scholar, selected to participate in this year-long program
2010 UNC GI Fellows Award for Excellence in Mentoring
2010 Best Doctors in America, elected by peers, 2011-2014.
2011 ACG Governors Award for Excellence in Clinical Research at the 2011 ACG meeting
2012 AGA-June and Donald O. Castell Esophageal Clinical Research Award
2012 Gastroenterology Research Group-AGA Young Investigator Clinical Science Award
2012 Ruth and Phillip Hettleman Prize for Artistic and Scholarly Achievement at UNC
C. Selected Peer-reviewed Publications (Selected from 109 peer-reviewed publications)
Most relevant to the current application
1. Dellon ES, Aderoju A, Woosley J, Sandler RS, Shaheen NJ. Variability in diagnostic criteria for
eosinophilic esophagitis: A systematic review. Am J Gastroenterol 2007; 102:2300-2313. [PMID
17617209]
2. Dellon ES, Gibbs WB, Fritchie KJ, Rubinas TC, Wilson LA, Woosley JT, Shaheen NJ. Clinical,
endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux
disease. Clin Gastroenterol Hepatol 2009; 7:2695-2703. [PMID 19733260; PMC2789852]
3. Dellon ES, Gibbs WB, Rubinas TC, Fritchie KJ, Madanick RD, Woosley JT, Shaheen NJ. Esophageal
dilation in eosinophilic esophagitis: Safety and predictors of clinical response and complications.
Gastroinest Endosc 2010; 71: 706-12. [PMID 20170913; PMC Journal – In Process]
4. Dellon ES, Chen X, Miller CR, Fritchie KF, Rubinas TC, Woosley JT, Shaheen NJ. Tryptase staining of
mast cells may differentiate eosinophilic esophagitis from gastroesophageal reflux disease. Am J
Gastroenterol 2011; 106: 264-71. [PMID 20978486; PMC Journal – In Process]
5. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood S, Bonis PA, Burks W, Chehade M, Collins MH,
Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka D, Lucendo AJ, Markowitz J, Noel RJ,
Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ,
Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves S. Eosinophilic
Esophagitis: Updated Consensus Recommendations for Children and Adults. J Allergy Clin Immunol,
2011; 128: 3-20. [PMID 21477849; PMC Journal – In Progress]
6. Dellon ES, Peery AP, Shaheen NJ, Morgan DM, Hurrell JM, Lash RH, Genta RM. Inverse association of
esophageal eosinophilia with Helicobacter pylori infection based on analysis of a US pathology database.
Gastroenterology. 2011; 141: 1586-1592 [PMID 21762663; PMC Journal – In Process]
7. Dellon ES, Sheikh A, Speck O, Woodward K, Whitlow AB, Hores J, Ivanovic M, Chau A, Woosley JT,
Madanick RD, Orlando RC, Shaheen NJ. Viscous topical is more effective than nebulized steroid therapy
for patients with eosinophilic esophagitis. Gastroenterology. 2012; 143: 321-324.e1. [PMID 22561055;
PMC Journal – In Process]
8. Kim HP, Vance RB, Shaheen NJ, Dellon ES. The prevalence and diagnostic utility of endoscopic features
of eosinophilic esophagitis: A meta-analysis. Clin Gastroenterol Hepatol. 2012; 10: 988-996.e5. [PMID
22610003; PMC Journal – In Process]
9. Dellon ES, Chen X, Miller CR, Woosley JT, Shaheen NJ. Diagnostic utility of major basic protein, eotaxin3, and leukotriene enzyme staining in eosinophilic esophagitis. Am J Gastroenterol. In press, 2012. Epub
July 10, 2012. [PMID 22777338; PMC Journal – In Process]
10. Dellon ES,* Gonsalves N,* Hirano I,* Furuta GT, Liacouras CA, Katzka DA. Evidence based approach to
the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J
Gastroenterol. 2103; 108: 679-92. [PMID 23567357; PMC Journal – In Process] (*Co-first authors)
11. Jensen ET, Kappelman MD, Kim HP, Ringel-Kukla T, Dellon ES. Early life exposures as risk factors for
pediatric eosinophilic esophagitis: A pilot and feasibility study. J Pediatr Gastroenterol Nutr. 2013; 57: 6771.
12. Dellon ES, Jensen EC, Martin CF, Shaheen NJ, Kappelman MD. The prevalence of eosinophilic
esophagitis in the United States. Clin Gastro Hepatol. 2014; 12: 589-596.e1.
13. Wolf WA, Jerath MR, Sperry SLW, Shaheen NJ, Dellon ES. Dietary elimination therapy is an effective
option for adults with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2014; 12: 1272-9.
14. Dellon ES, Rusin S, Gebhart JH, Covey S, Higgins LL, Beitia R, Speck O, Woodward K, Woosley JT,
Shaheen NJ. Utility of a non-invasive serum biomarker panel for diagnosis and monitoring of EoE: A
prospective study. Am J Gastroenterol. In press, 2015
15. Burk CM,* Beitia R, Lund PK, Dellon ES. High rate of galactose-alpha-1,3-galactose sensitization in both
eosinophilic esophagitis and patients undergoing upper endoscopy. Dis Esoph. In press, 2015. (*2014
CMSRP summer student)
D. Research Support
Ongoing Research Support
NIH K23 DK090073
Dellon (PI)
9/15/2011-7/31/2015
Risk factors and biomarkers for diagnosis and treatment of eosinophilic esophagitis
The goals of this proposal are to validate our previously developed model of risk factors for diagnosis of EoE,
to assess the utility of serum levels of eotaxin-3 and IL-13 as non-invasive biomarkers in diagnosis and
monitoring of treatment of EoE (but there is not an aim to predict treatment response using baseline values),
and to develop the PI’s career via a comprehensive training plan designed to increase his knowledge of
translational research techniques.
ACG Clinic Research Award
Dellon (PI)
7/1/2013-6/30/2015
Gene-environment interactions in the development of eosinophilic esophagitis
The goal of the proposed study is to assess whether there is interaction between the eotaxin-3 SNP and
selected early life exposures that increase odds of developing EoE in children, specifically antibiotic use in
infancy and Cesarean delivery.
CURED Foundation
Dellon (PI)
7/1/2014-6/30/2015
Diagnosis and monitoring of eosinophilic esophagitis using the Cytosponge
The goal of this project is to assess the safety, acceptability, and accuracy of Cytosponge for diagnosis and
monitoring of EoE in comparison to endoscopy and biopsy as the gold standard
NIH R01 CA168959
Mehrotra, PI
8/1/2013-4/30/2017
Measuring and improving colonoscopy quality using natural language processing
Evaluation of Growth Outcomes in Children with Eosinophilic Esophagitis
Introduction
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease characterized by eosinophilic infiltration of
esophageal epithelium. Adult patients typically present with food impaction and dysphagia, whereas children
present with vomiting, feeding dysfunction, and failure to thrive.1 EoE is thought to be an allergic disease
with the underlying pathogenesis related to exposure to food allergens.2 Accordingly, dietary elimination is an
effective initial therapy for EoE. Strategies for dietary treatment include selective elimination diets, in which
potential food allergens are removed from the diet, and elemental formulas, in which hypoallergenic liquid
formulations are administered as the sole source of nutrition.
Growth and development is a major concern for pediatric EoE patients, as feeding dysfunction and restrictive
diets can prevent patients with EoE from receiving sufficient nutrient intake. Moreover, elimination diets can
lead to poor growth and development if nutritional replacements for the eliminated food are not provided.3
Milk and wheat, the two most common allergic triggers of EoE,1 are highly important parts of a child’s diet,
and replacement sources are necessary to ensure normal growth and development.3 Use of elemental formulas
can circumvent these disadvantages because they provide a complete source of nutrients. Thus, elemental
formulas may help children with EoE achieve normal growth by providing a more complete source of
nutrients compared to restrictive diets. However, despite the importance of nutrition and growth in children
with EoE, outcomes related to growth and EoE-specific treatments have never been examined, and this is a
major gap in knowledge. The proposed study seeks to investigate the growth rates for pediatric EoE patients
using elemental formulas as compared to elimination diets and pharmacological therapies. We will analyze
patient data from the Carolinas EoE Collaborative (CEoEC), a multi-center network that includes UNC
(Chapel Hill, NC), Asthma and Allergy Specialists Clinic (Charlotte, NC), and Greenville Health System
Children’s Hospital Pediatric Gastroenterology Clinic (Greenville, SC).
Specific Aims and Hypotheses
Aim 1: To determine the growth rates of children with EoE who were treated initially with elemental formula
therapy as compared to those who were initially administered topical steroids and dietary elimination
therapies.
Hypothesis for Aim 1: Growth rates will be higher in pediatric EoE patients on an elemental formula therapy
than those not on an elemental formula therapy.
Aim 2: Evaluate the growth of children with refractory EoE (no response to pharmacological or diet
elimination therapies) who were placed on elemental formula as compared with the growth of children with
refractory EoE who were placed on other second-line treatments.
Hypothesis for Aim 2: Children with refractory EoE will have an improved growth rate after starting an
elemental formula diet.
Background
Eosinophilic Esophagitis: Symptoms and Diagnosis
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that is characterized by eosinophilic
infiltration of esophageal epithelium. Adult patients typically present with food impaction and dysphagia,
whereas children typically present with vomiting, abdominal pain, feeding dysfunction, and failure to thrive.1
Diagnosis of EoE is based on these clinical symptoms and histological evidence of eosinophilic infiltration of
the esophageal epithelium.1 Treatments for EoE currently include topical steroids (fluticasone, budesonide),
dietary therapies, and endoscopic dilation.1
EoE is linked to food allergies
EoE is currently thought to be an allergic disease based on epidemiological data, pathophysiological evidence,
and clinical response to trigger food elimination. Like other atopic conditions such as asthma and allergic
rhinitis, incidence and prevalence of EoE has grown markedly in the past two decades.4-8 Cohort studies have
shown that the majority of EoE patients have concomitant asthma, allergic rhinitis, or atopic dermatitis.7 At
the cellular level, EoE is largely a TH2 mediated response, with IL-5 and IL-13 cytokines being critically
involved in EoE pathogenesis.7,9-11 Histological remission and symptom improvement in EoE patients
undergoing elimination diets provides clinical evidence supporting the link between EoE and food allergies.2
Dietary therapies are effective as treatment of EoE patients
Both elemental diets and elimination diets are effective in managing EoE in children.3 Elemental diets involve
replacing all intact protein in the diet with a liquid formulation of amino acids.16 Elemental diets have been
shown to be more effective at inducing remission than any other therapy including topical steroids,16 and are
much more likely to achieve mucosal healing and result in lower residual eosinophil counts.3 However, the
high cost of elemental formulas, poor oral tolerability, and need for a feeding tube for certain patients are
disadvantages of this approach.1 Because of this, elimination diets based on either allergy test results
(“targeted elimination diets”) or with the six most common allergens eliminated (“six-food elimination diets”;
SFED) have been developed. Response rates for these approaches range from 60-75%, a level that is
comparable to pharmacologic therapy.17
Growth is an important but poorly described consideration in pediatric EoE patients
Children with EoE who present with feeding dysfunction can develop maladaptive feeding behaviors.13
Moreover, dietary therapies used to address such symptoms can often lead to impairments in nutritional
intake, which can affect growth.3 When compared to healthy controls and expected values based on age,
children with food allergies in general, and allergy to cow’s milk in particular, show decreased growth.14,15
While monitoring nutritional intake is important when children are placed on long-term elimination diets,2
outcomes related to this for EoE are poorly described in the current literature. In particular, there is a
surprising and unacceptable lack of data concerning growth outcomes based on treatment type. Further
research is needed to better understand how dietary management of EoE in children impacts growth rates.
Present Study
To date, elemental diets, elimination diets, and other EoE treatments have only been compared for their
effectiveness in producing clinical and histological remissions. Growth, which is especially important in
children with EoE, has not been extensively assessed as a specific outcome, and the various treatment
modalities have not been compared with respect to growth outcomes. Analyzing these differences could help
pediatric gastroenterologists and nutritionists guide the treatment of pediatric EoE patients and select optimal
treatment and nutritional approaches. Therefore, the overall goal of this study is to assess growth outcomes by
treatment types in children with EoE, and the central hypothesis is that those who take elemental formula will
have better growth outcomes. To do this, we will analyze data from children with EoE from three centers in
the Carolinas EoE Collaborative (CEoEC), a consortium of EoE centers in North and South Carolina cofounded and co-directed by the faculty advisor on this project.
Research Design and Methods
Study Population
Our study population will include all children (<18) diagnosed with EoE at University of North Carolina
Hospitals (Chapel Hill, NC), Asthma and Allergy Specialists Clinic (Charlotte, NC), and Greenville Health
System Children’s Hospital Pediatric Gastroenterology Clinic (Greenville, SC), three of the centers in the
CEoEC. We will review records from 2005 - 2014. To assess growth, we will include patients who have at
least 3 visits.
Study Design and Data
This will be a retrospective cohort study. Data on age, demographic, clinical symptoms, endoscopic features,
histological findings, anthropometric measures (height, weight, growth velocity), treatment approaches and
adherence, and frequency of encounters with the physician and nutritionist will be extracted using a
standardized case report form. The same form will be utilized at all sites.
Student’s Role
The student’s role in this study will be to assist in the study’s design, medical record data abstraction, data
analysis, and write up of the results of the study for presentation and publication.
Data Analysis
Statistical analysis
Demographic, clinical, endoscopic, histologic, and treatment-related data for the study population will be
summarized using descriptive statistics. Baseline characteristics of EoE patients will be compared by
treatment type (steroids vs dietary elimination vs elemental formula) and by the presence or absence of
elemental formula supplementation. The primary outcome of interest will be growth. We will use metrics
standardized to a normative population, and will specifically calculate both the change in the BMI Z-score
and the change in height Z-score pre- and post-therapy. To test the hypotheses stated above, these changes
will be compared between initial treatment types (Aim 1) and for refractory treatment types (Aim 2). A
longitudinal modeling approach will accommodate adjustment for potential confounders (ie presence of other
atopic conditions, EoE disease duration, age, gender, etc), use of multiple data points over time, with variable
numbers of data points per subject. We will explore whether a linear mixed effects model may be appropriate
to assess change over time, introducing a random effect for intercept (baseline BMI Z-score).
Sample Size
We have already established that, between 2005 and 2014, approximately 700 pediatric patients have been
treated for EoE at the above three centers in the CEoEC.
Aim 1: Assuming 80% of patients have a minimum of 3 visits on record, we anticipate a study sample of 560
patients.
Aim 2: Of these 560 patients, assuming 40% are refractory to first line elimination diet or pharmacological
treatments, we anticipate a study sample of 224 patients.
Expected Outcome / Alternative Approaches
We predict that EoE patients receiving elemental formulas will have favorable growth rates than EoE patients
not on elemental formulas. We also predict that EoE patients refractory to other treatments will regain or
experience improved growth following the initiation of elemental diet therapy. It is possible that a number of
subjects may have incomplete follow-up data. If that is the case, we will first then compare those with and
without incomplete records or missing data to assess for systematic biases. If this does not resolve this issue,
we can modify our IRB applications to contact the pediatricians of the patients with incomplete records to
acquire the necessary growth data.
Candidates Statement
The CMSRP program was designed to provide students like me with a meaningful exposure to medical
research. My undergraduate and medical studies have peaked my interest in research and the generation of
new knowledge, and thus, I believe I would be a perfect fit for this program. This experience will not only be
invaluable to my development as a physician-scientist, but will also help me explore the possibilities of
pursuing an academic career in medical research in the future. During the course of this research study, I will
gain experience working on all aspects of this project, including study design, data collection, analysis, and
reporting of results. I am very much looking forward to the process of gaining these skills and working with
Dr. Dellon on this project during the upcoming summer.
Bibliography
1. Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: Evidenced based approach to the
diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J
Gastroenterol. 2013;108(5):679-92.
2. Kagalwalla AF. Dietary treatment of eosinophilic esophagitis in children. Dig Dis. 2014;32(1-2):114-9.
3. Mehta H, Groetch M, Wang J. Growth and nutritional concerns in children with food allergy. Curr Opin
Allergy Clin Immunol. 2013;13(3):275-9.
4. Dellon ES. Epidemiology of eosinophilic esophagitis. Gastroenterol Clin North Am. 2014;43(2):201-18.
5. Hruz P, Straumann A, Bussmann C, et al. Escalating incidence of eosinophilic esophagitis: a 20-year
prospective, population-based study in Olten County, Switzerland. J Allergy Clin Immunol.
2011;128(6):1349-1350.e5.
6. Lin SK, Sabharwal G, Ghaffari G. A review of the evidence linking eosinophilic esophagitis and food
allergy. Allergy Asthma Proc. 2015;36(1):26-33.
7. Brown-whitehorn TF, Spergel JM. The link between allergies and eosinophilic esophagitis: implications for
management strategies. Expert Rev Clin Immunol. 2010;6(1):101-9.
8. Okada H, Kuhn C, Feillet H, Bach JF. The 'hygiene hypothesis' for autoimmune and allergic diseases: an
update. Clin Exp Immunol. 2010;160(1):1-9.
9. Maggi E. The TH1/TH2 paradigm in allergy. Immunotechnology. 1998;3(4):233-44.
10. Bhardwaj N, Ghaffari G. Biomarkers for eosinophilic esophagitis: a review. Ann Allergy Asthma
Immunol. 2012;109(3):155-9.
11. Blanchard C, Wang N, Stringer KF, et al. Eotaxin-3 and a uniquely conserved gene-expression profile in
eosinophilic esophagitis. J Clin Invest. 2006;116(2):536-47.
12. Matsuura H, Ishiguro A, Abe H, et al. Elevation of plasma eotaxin levels in children with food allergy.
Nihon Rinsho Meneki Gakkai Kaishi. 2009;32(3):180-5.
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