A Clinical Prediction Tool Identifies Cases of Eosinophilic Esophagitis Without Endoscopic Biopsy: A Prospective Study

Abstract

Objectives Eosinophilic esophagitis (EoE) is difficult to distinguish from gastroesophageal reflux (GERD) and other causes of dysphagia. We assessed the utility of a set of clinical and endoscopic features for predicting EoE without obtaining esophageal biopsies. Methods We prospectively enrolled consecutive adults undergoing outpatient upper endoscopy at University of North Carolina from 7/2011–12/2013. Incident cases of EoE were diagnosed per consensus guidelines. Non-EoE controls had either GERD- or dysphagia-predominant symptoms. A predictive model containing clinical and endoscopic, but no histologic data was assessed. Receiver operator characteristic (ROC) curves were constructed and the area under the curve (AUC) was calculated. Results A total of 81 EoE cases (mean age 38 years; 60% male; 93% white; 141 eos/hpf) and 144 controls (mean age 52, 38% male; 82% white; 3 eos/hpf) were enrolled. A combination of clinical (age, sex, dysphagia, food allergy) and endoscopic (rings, furrows, plaques, hiatal hernia) features was highly predictive of EoE. The AUC was 0.944, with sensitivity, specificity, and accuracy of 84%, 97%, and 92%. Similar values were seen after limiting controls to those with only reflux or dysphagia, or to those with esophageal eosinophilia not due to EoE. Conclusions We validated a set of clinical and endoscopic features to predict EoE with a high degree of accuracy, and allow identification of those at very low risk of disease. Use of these predictors at the point-of-care will avoid the effort and expense of low-yield histological examinations for EoE.

Clinical symptom tool that raises the index of suspicion for eosinophilic oesophagitis in adults and drives earlier biopsy for definitive diagnosis

“…A comprehensive and very thorough prospective investigation of 144 EoE and 81 non-EoE cases has been described by Dellon et al 23 In a manner similar to our model, clinical and endoscopic variables implicating EoE were identified. Eight variables (age, sex, dysphagia, food allergy, endoscopic rings, furrows, plaques and hiatial hernia) in a predictive model gave an AUC of 0.944, and 92% of the patients were correctly assigned, with a sensitivity of 84%, a specificity of 97%, and positive and negative predictive values of 93-91%.…”

“…A comprehensive and very thorough prospective investigation of 144 EoE and 81 non‐EoE cases has been described by Dellon et al . In a manner similar to our model, clinical and endoscopic variables implicating EoE were identified.…”

Prospective assessment of serum periostin as a biomarker for diagnosis and monitoring of eosinophilic oesophagitis

“…Full details of the study design have been previously described. [28][29][30][31][32] In brief, patients aged 18-80 years who were undergoing outpatient upper endoscopy for evaluation of symptoms of oesophageal dysfunction (e.g. dysphagia, food impaction, heartburn, reflux, chest pain) were consecutively enrolled.…”

A 34-year-old man with refractory heartburn and intermittent dysphagia to solids

“…Certain clinical factors (age < 50 yr, male sex, presence of dysphagia and food allergies) combined with specific endoscopic features (presence of esophageal rings, furrows and plaques, and absence of hiatal hernia) predicted eosinophilic esophagitis with a sensitivity of 84%, specificity of 97% and accuracy of 92%. 8 An online calculator developed by the University of North Carolina's Center for Esophageal Disease and Swallowing is available to help predict the probability of this condition (https://gicenter.med.unc. edu/cedas/eoe_clinical_calculator.html).…”