Diagnostics of Eosinophilic Esophagitis: Clinical, Endoscopic, and Histologic Pitfalls

Dellon, Evan S.

doi:10.1159/000357009

Cited by 20 publications

(13 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,6,13 Dellon et al 4 assessed an EREFS inflammatory score, derived by adding the maximum score for edema, exudate, and furrows. We found this score well correlated with eosinophilia in all areas of the esophagus (proximal, mid, and distal), and ROC analysis showed the score accurately distinguished incident EoE from control, and post-treatment active from inactive disease.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Esophagitis Reference Score Accurately Identifies Disease Activity and Treatment Effects in Children

Wechsler

Bolton

Amsden

et al. 2018

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

BACKGROUND & AIMS The endoscopic reference score (EREFS) is used to determine severity of 5 endoscopic findings: edema, rings, exudates, furrows, and strictures. Little is known about the relationship between EREFSs and histologic markers of disease activity in children with eosinophilic esophagitis (EoE). We aimed to determine whether the EREFS can be used to identify children with EoE and how it changes with treatment. METHODS We performed a prospective study of consecutive children (ages 2–17 years) undergoing diagnostic or post-treatment endoscopy scored real-time with EREFS from December 2012 through 2016. Findings from 192 diagnostic endoscopies and 229 post-treatment endoscopies were evaluated, from 371 children. Incident EoE cases were diagnosed based on 2011 consensus guidelines. Patients were treated with either elimination diet or topical steroids. Subjects who underwent endoscopy for symptoms of esophageal dysfunction but had normal esophageal findings from histology analysis were used as controls. EREFS and receiver operating characteristic curves were determined for incident EoE cases (n = 77) vs controls (n = 115), patients with active EoE (n = 101) vs inactive EoE after treatment (n = 128), and paired pre- and post-treatment cases of EoE (n = 85). Component and composite scores were correlated with eosinophilia. RESULTS Visual detection of more than 1 esophageal abnormality during the diagnostic endoscopy identified children with EoE with 89.6% sensitivity and 87.9% specificity. EREFS correlated with peak level of eosinophilia (P < .001) at all esophageal levels. Children who responded to therapy had mean EREFSs of 0.5 compared to 2.4 in non-responders. In comparing pre-treatment vs post-treatment data from 85 patients, we found a significant reduction in the composite EREFS (from 2.4 to 0.7) (P < .001) among patients who responded to treatment; 92% of responders had a reduced EREFSs after treatment. EREFSs identified children with EoE with an area under the curve value (AUC) of 0.93. EREFSs identified children with active EoE following treatment with an AUC of 0.81 before treatment and an AUC of 0.79 after treatment. CONCLUSIONS In a prospective study of children undergoing diagnostic or post-treatment endoscopy, we found the EREFS to accurately identify those with EoE. Children who responded to therapy had lower EREFS scores than non-responders. EREFSs can be used to measure outcomes of pediatric patients, in conjunction with histology findings, and assess treatments for children with EoE.

show abstract

Section: Discussionmentioning

confidence: 99%

Eosinophilic Esophagitis Reference Score Accurately Identifies Disease Activity and Treatment Effects in Children

Wechsler

Bolton

Amsden

et al. 2018

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

“…1. Between 10 and 33% of children diagnosed with EoE have been reported as having visually normal esophageal mucosa [3, 4••, 9]. Each endoscopic finding may occur in isolation or combination.…”

Section: Endoscopic Findings At Diagnosismentioning

confidence: 99%

Eosinophilic Esophagitis in Children: Endoscopic Findings at Diagnosis and Post-intervention

Bolton

Kagalwalla

Wechsler

2018

Curr Gastroenterol Rep

View full text Add to dashboard Cite

Gold standard of diagnosis and assessment of response to therapy in EoE requires multiple endoscopies with biopsies for histology, which allows for observation of the esophageal mucosa. Typical endoscopic findings in patients with EoE include edema, exudate, furrowing, concentric rings, and strictures. Endoscopic findings have been broadly characterized into inflammatory features (edema, exudate, furrowing) and fibro-stenotic features (rings, stricture), in order to better reflect their underlying pathophysiology. Recent studies suggest strong correlations between endoscopic findings, through composite scoring systems, and histology, and therefore may be helpful as part of disease surveillance. The EoE Endoscopic Reference Score (EREFS) classification system was proposed in 2013 as an outcome metric for standardization in reporting endoscopic signs of EoE. Subsequent studies support utility of composite scoring, which utility has similarly been seen in pediatric treatment trials. Endoscopy in children provides insight into the natural history of EoE, with progressively more fibro-stenotic features occurring over time, giving an additional perspective into esophageal remodeling and response to treatment. Recognition of typical endoscopic findings at diagnosis and upon repeat endoscopy has allowed a clinician to monitor visual changes in esophageal mucosal health. Further studies to assess the role of composite scoring in disease management are needed.

show abstract

“…Several characteristic endoscopic findings have been identified in patients with EoE, including longitudinal furrows, rings, trachealization, white exudates, reduced esophageal distensibility, and mucosal frailty (9,18) (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

“…Among younger adults primary symptoms include dysphagia, usually intermittent and unpredictable, and food impaction (4,8). Less common complaints include heartburn, regurgitation and chest pain, which may on occasion mislead towards GERD (9,10). Furthermore, as this condition has an immune and allergic background, patients frequently exhibit comorbid atopy, asthma, and food allergies (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Impaired esophageal motor function in eosinophilic esophagitis

Santander¹,

Chavarría²,

Becerro-González³

et al. 2015

Rev Esp Enferm Dig

View full text Add to dashboard Cite

Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis.

show abstract

Diagnostics of Eosinophilic Esophagitis: Clinical, Endoscopic, and Histologic Pitfalls

Cited by 20 publications

References 41 publications

Eosinophilic Esophagitis Reference Score Accurately Identifies Disease Activity and Treatment Effects in Children

Eosinophilic Esophagitis Reference Score Accurately Identifies Disease Activity and Treatment Effects in Children

Eosinophilic Esophagitis in Children: Endoscopic Findings at Diagnosis and Post-intervention

Impaired esophageal motor function in eosinophilic esophagitis

Contact Info

Product

Resources

About