Cary C Cotton1, Renee Betancourt2, Cara Randall2, Irina Perjar2, Christine Bookhout2, John T Woosley2, Nicholas J Shaheen2, Evan S Dellon3. 1. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 3. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: edellon@med.unc.edu.
Abstract
BACKGROUND AND AIMS: Updated diagnostic guidelines for eosinophilic esophagitis (EoE) have eliminated the requirement for a proton pump inhibitor (PPI) trial, but there are no models to identify patients with EoE based on these new criteria. We aimed to develop a predictive model for diagnosis of EoE based on the updated EoE diagnostic guidelines. METHODS: We performed a secondary analysis of a prospective study of adult patients referred for outpatient esophagogastroduodenoscopy at University of North Carolina who had symptoms of esophageal dysfunction; patients with prevalent EoE were excluded. We analyzed data from 206 EoE cases (mean age 40.1, 62.6% male, 93.2% white) and 306 controls (mean age 52.3, 37.9% male, 79.7% white). We built predictive models for case-control status, using clinical, endoscopic, and histologic features, and defining EoE by either the new or historical definition of PPI non-response. Model discrimination was assessed by the area under the receiver-operator characteristic curve (AUC). RESULTS: Before endoscopy, younger age, male sex, history of atopic condition or food allergy, and dysphagia identified patients with EoE with an AUC of 0.83. When we included endoscopy findings suggestive of EoE, the model identified patients with EoE with an AUC of 0.92; this increased to 0.99 when histology was included. CONCLUSION: We developed a model to identify patients with EoE, without a trial of PPIs, based on updated diagnostic guidelines. Clinical features and endoscopic findings identified patients with EoE with an AUC of 0.92-even without histologic data and in the absence of dysphagia. This model can be used to select patients with upper gastrointestinal symptoms but without dysphagia for early diagnostic endoscopy. The model can also be used to identify cases of EoE when eosinophil counts are greater than 15 in biopsies but other causes of esophageal eosinophilia cannot necessarily be excluded.
BACKGROUND AND AIMS: Updated diagnostic guidelines for eosinophilic esophagitis (EoE) have eliminated the requirement for a proton pump inhibitor (PPI) trial, but there are no models to identify patients with EoE based on these new criteria. We aimed to develop a predictive model for diagnosis of EoE based on the updated EoE diagnostic guidelines. METHODS: We performed a secondary analysis of a prospective study of adult patients referred for outpatient esophagogastroduodenoscopy at University of North Carolina who had symptoms of esophageal dysfunction; patients with prevalent EoE were excluded. We analyzed data from 206 EoE cases (mean age 40.1, 62.6% male, 93.2% white) and 306 controls (mean age 52.3, 37.9% male, 79.7% white). We built predictive models for case-control status, using clinical, endoscopic, and histologic features, and defining EoE by either the new or historical definition of PPI non-response. Model discrimination was assessed by the area under the receiver-operator characteristic curve (AUC). RESULTS: Before endoscopy, younger age, male sex, history of atopic condition or food allergy, and dysphagia identified patients with EoE with an AUC of 0.83. When we included endoscopy findings suggestive of EoE, the model identified patients with EoE with an AUC of 0.92; this increased to 0.99 when histology was included. CONCLUSION: We developed a model to identify patients with EoE, without a trial of PPIs, based on updated diagnostic guidelines. Clinical features and endoscopic findings identified patients with EoE with an AUC of 0.92-even without histologic data and in the absence of dysphagia. This model can be used to select patients with upper gastrointestinal symptoms but without dysphagia for early diagnostic endoscopy. The model can also be used to identify cases of EoE when eosinophil counts are greater than 15 in biopsies but other causes of esophageal eosinophilia cannot necessarily be excluded.
Authors: Ulrike von Arnim; Thomas Wex; Friedrich-W Röhl; Helmut Neumann; Dörthe Küster; Jochen Weigt; Klaus Mönkemüller; Peter Malfertheiner Journal: Digestion Date: 2011-11-09 Impact factor: 3.216
Authors: Evan S Dellon; Chris A Liacouras; Javier Molina-Infante; Glenn T Furuta; Jonathan M Spergel; Noam Zevit; Stuart J Spechler; Stephen E Attwood; Alex Straumann; Seema S Aceves; Jeffrey A Alexander; Dan Atkins; Nicoleta C Arva; Carine Blanchard; Peter A Bonis; Wendy M Book; Kelley E Capocelli; Mirna Chehade; Edaire Cheng; Margaret H Collins; Carla M Davis; Jorge A Dias; Carlo Di Lorenzo; Ranjan Dohil; Christophe Dupont; Gary W Falk; Cristina T Ferreira; Adam Fox; Nirmala P Gonsalves; Sandeep K Gupta; David A Katzka; Yoshikazu Kinoshita; Calies Menard-Katcher; Ellyn Kodroff; David C Metz; Stephan Miehlke; Amanda B Muir; Vincent A Mukkada; Simon Murch; Samuel Nurko; Yoshikazu Ohtsuka; Rok Orel; Alexandra Papadopoulou; Kathryn A Peterson; Hamish Philpott; Philip E Putnam; Joel E Richter; Rachel Rosen; Marc E Rothenberg; Alain Schoepfer; Melissa M Scott; Neil Shah; Javed Sheikh; Rhonda F Souza; Mary J Strobel; Nicholas J Talley; Michael F Vaezi; Yvan Vandenplas; Mario C Vieira; Marjorie M Walker; Joshua B Wechsler; Barry K Wershil; Ting Wen; Guang-Yu Yang; Ikuo Hirano; Albert J Bredenoord Journal: Gastroenterology Date: 2018-09-06 Impact factor: 22.682
Authors: Javier Molina-Infante; Albert J Bredenoord; Edaire Cheng; Evan S Dellon; Glenn T Furuta; Sandeep K Gupta; Ikuo Hirano; David A Katzka; Fouad J Moawad; Marc E Rothenberg; Alain Schoepfer; Stuart J Spechler; Ting Wen; Alex Straumann; Alfredo J Lucendo Journal: Gut Date: 2015-12-18 Impact factor: 23.059
Authors: Evan S Dellon; Karen J Fritchie; Tara C Rubinas; John T Woosley; Nicholas J Shaheen Journal: Dig Dis Sci Date: 2009-10-15 Impact factor: 3.199
Authors: S H Mackenzie; M Go; B Chadwick; K Thomas; J Fang; S Kuwada; S Lamphier; K Hilden; K Peterson Journal: Aliment Pharmacol Ther Date: 2008-07-04 Impact factor: 8.171
Authors: Glenn T Furuta; Chris A Liacouras; Margaret H Collins; Sandeep K Gupta; Chris Justinich; Phil E Putnam; Peter Bonis; Eric Hassall; Alex Straumann; Marc E Rothenberg Journal: Gastroenterology Date: 2007-08-08 Impact factor: 22.682
Authors: Evan S Dellon; Cary C Cotton; Jessica H Gebhart; Leana L Higgins; RoseMary Beitia; John T Woosley; Nicholas J Shaheen Journal: Clin Gastroenterol Hepatol Date: 2015-09-25 Impact factor: 11.382
Authors: Evan S Dellon; Spencer Rusin; Jessica H Gebhart; Shannon Covey; Olga Speck; Kimberly Woodward; Leana L Higgins; RoseMary Beitia; Ryan D Madanick; Sidney Levinson; John T Woosley; Nicholas J Shaheen Journal: Am J Gastroenterol Date: 2015-08-25 Impact factor: 10.864
Authors: Craig C Reed; W Asher Wolf; Cary C Cotton; Spencer Rusin; Irina Perjar; Johnathan Hollyfield; John T Woosley; Nicholas J Shaheen; Evan S Dellon Journal: Clin Gastroenterol Hepatol Date: 2017-10-04 Impact factor: 11.382