Ekaterina Safroneeva1, Alex Straumann2, Michael Coslovsky1, Marcel Zwahlen1, Claudia E Kuehni1, Radoslaw Panczak1, Nadine A Haas1, Jeffrey A Alexander3, Evan S Dellon4, Nirmala Gonsalves5, Ikuo Hirano5, John Leung6, Christian Bussmann7, Margaret H Collins8, Robert O Newbury9, Giovanni De Petris10, Thomas C Smyrk11, John T Woosley12, Pu Yan13, Guang-Yu Yang14, Yvonne Romero15, David A Katzka3, Glenn T Furuta16, Sandeep K Gupta17, Seema S Aceves18, Mirna Chehade19, Jonathan M Spergel20, Alain M Schoepfer21. 1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 2. Swiss EoE Research Group, Praxis Römerhof, Olten, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland. 3. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 4. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 5. Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 6. Food Allergy Center at Tufts Medical Center and Floating Hospital for Children, Division of Allergy and Immunology, Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, Massachusetts. 7. Viollier AG, Basel, Switzerland. 8. Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 9. Department of Pathology, Rady Children's Hospital, University of California, San Diego, San Diego, California. 10. Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Scottsdale, Arizona. 11. Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota. 12. Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 13. Institut Universitaire de Pathologie de Lausanne, Lausanne, Switzerland. 14. Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 15. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota; GI Outcomes Unit, Mayo Clinic, Rochester, Minnesota. 16. Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. 17. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana. 18. Division of Allergy and Immunology, Rady Children's Hospital, University of California, San Diego, San Diego, California. 19. Departments of Pediatrics and Medicine, Mount Sinai Center for Eosinophilic Disorders, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 20. Divisions of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, Pennsylvania. 21. Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Electronic address: alain.schoepfer@chuv.ch.
Abstract
BACKGROUND & AIMS: It is not clear whether symptoms alone can be used to estimate the biologic activity of eosinophilic esophagitis (EoE). We aimed to evaluate whether symptoms can be used to identify patients with endoscopic and histologic features of remission. METHODS: Between April 2011 and June 2014, we performed a prospective, observational study and recruited 269 consecutive adults with EoE (67% male; median age, 39 years old) in Switzerland and the United States. Patients first completed the validated symptom-based EoE activity index patient-reported outcome instrument and then underwent esophagogastroduodenoscopy with esophageal biopsy collection. Endoscopic and histologic findings were evaluated with a validated grading system and standardized instrument, respectively. Clinical remission was defined as symptom score <20 (range, 0-100); histologic remission was defined as a peak count of <20 eosinophils/mm(2) in a high-power field (corresponds to approximately <5 eosinophils/median high-power field); and endoscopic remission as absence of white exudates, moderate or severe rings, strictures, or combination of furrows and edema. We used receiver operating characteristic analysis to determine the best symptom score cutoff values for detection of remission. RESULTS: Of the study subjects, 111 were in clinical remission (41.3%), 79 were in endoscopic remission (29.7%), and 75 were in histologic remission (27.9%). When the symptom score was used as a continuous variable, patients in endoscopic, histologic, and combined (endoscopic and histologic remission) remission were detected with area under the curve values of 0.67, 0.60, and 0.67, respectively. A symptom score of 20 identified patients in endoscopic remission with 65.1% accuracy and histologic remission with 62.1% accuracy; a symptom score of 15 identified patients with both types of remission with 67.7% accuracy. CONCLUSIONS: In patients with EoE, endoscopic or histologic remission can be identified with only modest accuracy based on symptoms alone. At any given time, physicians cannot rely on lack of symptoms to make assumptions about lack of biologic disease activity in adults with EoE. ClinicalTrials.gov, Number: NCT00939263.
BACKGROUND & AIMS: It is not clear whether symptoms alone can be used to estimate the biologic activity of eosinophilic esophagitis (EoE). We aimed to evaluate whether symptoms can be used to identify patients with endoscopic and histologic features of remission. METHODS: Between April 2011 and June 2014, we performed a prospective, observational study and recruited 269 consecutive adults with EoE (67% male; median age, 39 years old) in Switzerland and the United States. Patients first completed the validated symptom-based EoE activity index patient-reported outcome instrument and then underwent esophagogastroduodenoscopy with esophageal biopsy collection. Endoscopic and histologic findings were evaluated with a validated grading system and standardized instrument, respectively. Clinical remission was defined as symptom score <20 (range, 0-100); histologic remission was defined as a peak count of <20 eosinophils/mm(2) in a high-power field (corresponds to approximately <5 eosinophils/median high-power field); and endoscopic remission as absence of white exudates, moderate or severe rings, strictures, or combination of furrows and edema. We used receiver operating characteristic analysis to determine the best symptom score cutoff values for detection of remission. RESULTS: Of the study subjects, 111 were in clinical remission (41.3%), 79 were in endoscopic remission (29.7%), and 75 were in histologic remission (27.9%). When the symptom score was used as a continuous variable, patients in endoscopic, histologic, and combined (endoscopic and histologic remission) remission were detected with area under the curve values of 0.67, 0.60, and 0.67, respectively. A symptom score of 20 identified patients in endoscopic remission with 65.1% accuracy and histologic remission with 62.1% accuracy; a symptom score of 15 identified patients with both types of remission with 67.7% accuracy. CONCLUSIONS: In patients with EoE, endoscopic or histologic remission can be identified with only modest accuracy based on symptoms alone. At any given time, physicians cannot rely on lack of symptoms to make assumptions about lack of biologic disease activity in adults with EoE. ClinicalTrials.gov, Number: NCT00939263.
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