A Model Using Clinical and Endoscopic Characteristics Identifies Patients at Risk for Eosinophilic Esophagitis According to Updated Diagnostic Guidelines

Cotton, Cary C.; Betancourt, Renée; Randall, Cara; Perjar, Irina; Bookhout, Christine; Woosley, John T.; Shaheen, Nicholas J.; Dellon, Evan S.

doi:10.1016/j.cgh.2020.06.068

Cited by 15 publications

(12 citation statements)

References 33 publications

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“…Clinical data and histopathology slides were obtained from 2 previous prospective studies conducted at the University of North Carolina and at the Academic Medical Center, University of Amsterdam (20)(21)(22). Patients with a confirmed diagnosis of EoE were treated for 8 weeks with dietary exclusion (6-food elimination diet) or swallowed topical budesonide.…”

Section: Study Populationmentioning

confidence: 99%

Responsiveness of a Histologic Scoring System Compared With Peak Eosinophil Count in Eosinophilic Esophagitis

Jairath

Feagan

et al. 2021

Am J Gastroenterol

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INTRODUCTION:The optimal instrument for assessing histologic disease activity in patients with eosinophilic esophagitis (EoE) is unclear. We assessed the responsiveness of the EoE Histologic Scoring System (EoE-HSS) when compared with that of the peak eosinophil count (PEC).METHODS:Histopathology slides were obtained from patients with EoE at baseline and after 8 weeks of treatment with swallowed topical budesonide or elimination diet. Two blinded gastrointestinal pathologists scored biopsies on the EoE-HSS, PEC, and 100-mm visual analog scale (VAS) of overall histologic severity. Change was defined as an improvement by ≥0.5 SD in baseline VAS. Responsiveness was quantified using the standardized effect size (SES) and the probability that the index distinguishes a patient with improvement from a patient without improvement, which is the area under the receiver operating characteristic curve (AUC). Longitudinal validity was assessed using Pearson correlations between changes in EoE-HSS and both PEC and VAS.RESULTS:The EoE-HSS grade (SES 2.18 [95% confidence interval, CI: 1.46–2.88]; AUC 0.73 [95% CI: 0.57–0.84]) and stage (SES 2.07 [95% CI: 1.37–2.77]; AUC 0.73 [95% CI: 0.58–0.84]) were highly responsive, similar to PEC (SES 1.44 [95% CI: 0.80–2.07]; AUC 0.73 [95% CI: 0.58–0.84]). The EoE-HSS grade and stage were more highly correlated with changes in VAS (grade 0.92 [95% CI: 0.86–0.95]; stage 0.89 [95% CI: 0.81–0.94]) than with changes in PEC (grade 0.74 [95% CI: 0.58–0.85]; stage 0.66 [95% CI: 0.47–0.80]).DISCUSSION:The EoE-HSS is highly responsive, performs similarly to PEC, and is better correlated with changes in overall histologic activity in patients with EoE.

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Section: Study Populationmentioning

confidence: 99%

Responsiveness of a Histologic Scoring System Compared With Peak Eosinophil Count in Eosinophilic Esophagitis

Jairath

Feagan

et al. 2021

Am J Gastroenterol

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“…We performed a secondary analysis of a prospective cohort study of patients with EoE, the details of which have been previously reported [10,[25][26][27][28]. In the parent study, patients with symptoms of esophageal dysfunction (e.g.…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

“…For the current study, patients were included if they were adults (≥18 years old) who had an incident diagnosis of EoE and did not meet the threshold for histologic responsiveness (<15 eos/hpf) after PPI-only therapy (at a total daily dose of 40-80 mg of any of the approved medications, for at least 8 weeks; the follow-up endoscopy was performed after the initial 8 weeks of PPI treatment, while the patient was still taking a PPI). For study inclusion, patients also had to have both the pre-PPI and post-PPI treatment esophageal biopsies available for re-review by the study pathologists, which decreased the sample size somewhat from our previously reported largest cohort [26].…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

Effect of Proton Pump Inhibitor Treatment in “PPI Non-responsive” Patients with Eosinophilic Esophagitis

Thakkar

Philpott

LaFata

et al. 2023

JGLD

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Background and Aims: Some eosinophilic esophagitis (EoE) patients can have a decline in eosinophil count after proton pump inhibitor (PPI) treatment without achieving histologic response, but little is known about this group. We aimed to determine the effect of PPIs on reducing esophageal eosinophilia in patients deemed non-responsive to PPI therapy. Methods: We analyzed prospectively collected cohort data from newly diagnosed adults with EoE who were histologic non-responders (≥15 eos/hpf) to PPI-only therapy. Symptoms, endoscopic histologic features were assessed before and after PPI. Pre- and post-PPI treatment esophageal biopsies were read by pathologists to determine peak eosinophil counts and other histologic findings. Results: Of 125 patients, peak eosinophil counts were 102.1 ± 69.8 and 102.9 ± 101.1 (p=0.93) before and after PPI treatment, respectively, but lamina propria fibrosis decreased from 97% to 41% (p<0.001). Heartburn frequency also decreased (19% to 11%; p=0.006), though endoscopic findings did not change. There were 75 patients (60%) who had some decrease in eosinophil counts, with 30 patients (24%) having ≥50% decrease in counts. When comparing the ≥50% and <50% decrease groups, differences in endoscopic features were identified, but the ≥50% group had improvement in eosinophil degranulation, microabscesses, spongiosis, and basal cell hyperplasia. Conclusion: Peak eosinophil counts did not decrease overall after PPI treatment, but symptoms of heartburn improved. Approximately a quarter had ≥50% decrease in eosinophil counts, with associated decreases in other histologic findings. Further research may consider what role PPIs have in this subset of non-responders or in combination therapies.

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“…Since there exists no test to rule out GERD, the clinical presentation of the patient is key and a precise history of symptoms is of crucial importance. An interesting approach is suggested by Cotton et al, who proposed a diagnostic model for diagnosing EoE demonstrating dysphagia as the most reliable predictor [106].…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

Eosinophilic esophagitis—established facts and new horizons

2021

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Despite dramatic advances in our understanding of the pathogenesis and course of disease in the relatively short timeframe since the discovery and first description of eosinophilic esophagitis (EoE) less than three decades ago, many open questions remain to be elucidated. For instance, we will need to better characterize atypical clinical presentations of EoE and other forms of esophageal inflammatory conditions with often similar clinical presentations, nut fulfilling current diagnostic criteria for EoE and to determine their significance and interrelationship with genuine EoE. In addition, the interrelationship of EoE with other immune-mediated diseases remains to be clarified. Hopefully, a closer look at the role of environmental factors and their interaction with genetic susceptibility often in context of atopic predisposition may enable identifying the candidate substances/agents/allergens and potentially earlier (childhood) events to trigger the condition. It appears plausible to assume that in the end—comparable to current concepts in other immune-mediated chronic diseases, such as for instance inflammatory bowel disease or asthma bronchiale—we will not be rewarded with the identification of a “one-and-only” underlying pathogenetic trigger factor, with causal responsibility for the disease in each and every EoE patient. Rather, the relative contribution and importance of intrinsic susceptibility, i.e., patient-driven factors (genetics, aberrant immune response) and external trigger factors, such as food (or aero-) allergens as well as early childhood events (e.g., infection and exposure to antibiotics and other drugs) may substantially differ among given individuals with EoE. Accordingly, selection and treatment duration of medical therapy, success rates and extent of required restriction in dietary treatment, and the need for mechanical treatment to address strictures and stenosis require an individualized approach, tailored to each patient. With the advances of emerging treatment options, the importance of such an individualized and patient-centered assessment will increase even further.

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A Model Using Clinical and Endoscopic Characteristics Identifies Patients at Risk for Eosinophilic Esophagitis According to Updated Diagnostic Guidelines

Cited by 15 publications

References 33 publications

Responsiveness of a Histologic Scoring System Compared With Peak Eosinophil Count in Eosinophilic Esophagitis

Responsiveness of a Histologic Scoring System Compared With Peak Eosinophil Count in Eosinophilic Esophagitis

Effect of Proton Pump Inhibitor Treatment in “PPI Non-responsive” Patients with Eosinophilic Esophagitis

Eosinophilic esophagitis—established facts and new horizons

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