The accuracy of endoscopic features in eosinophilic esophagitis: the experience in children from rural West Virginia.

GOAL: We assessed the accuracy of esophageal endoscopic features in children with eosinophilic esophagitis (EoE) living in rural communities in West Virginia.
BACKGROUND: Specific esophageal endoscopic features for EoE disease have been identified in children and adults. In the published reports, the sensitivity of these features ranged between 19% and 56%. The accuracy of these features in children with EoE living in rural communities has not been published.
RESULTS: A total of 271 patients' charts were reviewed of whom 53 children had EoE, 103 had gastroesophageal reflux disease, and 115 had normal esophagus. The calculated sensitivity, specificity, positive and negative predictive values, and accuracy rate for the presence of any mucosal feature for EoE disease were 88% (95% CI, 76-95), 98% (95% CI, 92-99), 96% (95% CI, 84-99), 94% (95% CI, 87-97), and 94.8%, respectively. The odds ratios for endoscopic furrows and erythema in EoE and gastroesophageal reflux disease patients were 155.4 (95% CI: 33.5, 719.8) and 13.4 (95% CI: 5.9, 30.5), respectively. When EoE patients were compared with normal patients, the odds ratio for erythema was 95.8 (95% CI: 31.4, 292.6). Dysphagia and choking were significantly more common in EoE children compared with control groups (P<0.001).
CONCLUSIONS: Esophageal features of EoE in children living in rural communities have a high accuracy rate for the diagnosis of EoE compared with the data reported from children living in urban/semiurban communities. We suggest that in a proper clinical scenario, therapeutic measurement could be started before histology results are available. Future investigation of the phenotypic presentation of EoE disease in children from rural communities is warranted.