Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis

Safroneeva, Ekaterina; Straumann, Alex; Coslovsky, Michael; Zwahlen, Marcel; Kuehni, Claudia E.; Panczak, Radoslaw; Haas, Nadine A.; Alexander, Jeffrey A.; Dellon, Evan S.; Gonsalves, Nirmala; Hirano, Ikuo; Leung, John; Bussmann, Christian; Collins, Margaret H.; Newbury, Robert; Petris, Giovanni De; Smyrk, Thomas C.; Woosley, John T.; Yan, Ping; Yang, Guang–Yu; Romero, Yvonne; Katzka, David A.; Furuta, Glenn T.; Gupta, Sandeep K.; Aceves, Seema S.; Chehade, Mirna; Spergel, Jonathan M.; Schoepfer, Alain; Achem, Sami R.; Arora, Amindra S.; Alpan, Oral; Armstrong, David; Attwood, Stephen; Butterfield, Joseph H.; Crowell, Michael D.; DeVault, Kenneth R.; Drouin, Éric; Enav, Benjamin; Enders, Felicity; Fleischer, David E.; Foxx‐Orenstein, Amy E.; Francis, Dawn L.; Guyatt, Gordon; Harris, Lucinda A.; Kagalwalla, Amir F.; Kita, Hirohito; Krishna, Murli; Lee, James J.; Lewis, Jason; Lim, Kaiser G.; Locke, G. Richard; Murray, Joseph A.; Nguyen, Cuong C.; Orbelo, Diana M.; Pasha, Shabana F.; Ramirez, Francisco C.; Sheikh, Javed; Umar, Sarah B.; Weiler, Catherine R.; Wo, John M.; Wu, Tsung–Teh; Yost, Kathleen J.

doi:10.1053/j.gastro.2015.11.004

Cited by 278 publications

(187 citation statements)

References 35 publications

(39 reference statements)

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“…For ease of description of the spectrum of definitions of histological remission of EoE, we classified the histological definitions into three categories: 0 to ≤5, 6 to ≤10, and 11 to ≤15. We excluded two studies with definitions outside these three categories 17, 18. As the majority of studies were conducted in the United States and Europe, we classified these studies into two regions to examine variability within and between regions.…”

Section: Methodsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinophils per microscopic high‐powered field [hpf]) remain the most common end‐point used to define response. Yet, the threshold for defining “response” and “remission” are ill‐defined among consensus guidelines and may vary from study to study. We conducted a systematic literature review of articles on eosinophilic esophagitis, published between January 2007 and November 2017, considering histological remission as the primary outcome. We abstracted treatment information and definitions of histological remission or response. A comparison of definitions of histological remission across and within institutions was performed. A total of 61 articles were included in this review, with approximately 60% of the studies published from centers in the United States. Histological definitions of remission of EoE ranged from 0 to ≤20 eosinophils/hpf. The most stringent criteria, ranging from 0 to ≤5 eosinophils/hpf, were commonly used in interventional trial studies that examined the effects of new treatments. We found remarkable variability in definitions between studies, treatment types, and regions. Age or epidemiological distribution of study subjects did not influence the criteria for histological remission. Clinical and histological improvements are important measures of the effects of treatment. Histological findings, the most objective measure of treatment, should provide an optimal method for comparing the effectiveness of various treatments. Yet, our findings suggest a lack of consistent remission criteria in published studies. Considering these inconsistencies, it is difficult to compare the effectiveness of various treatments.

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Section: Methodsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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“…Assessment of clinical and biologic disease activity is based on validated instruments designed specifically for EoE and PPI-REE [22,25,26]. The cross-sectional capture of data regarding clinical activity, EoE-specific quality of life, and endoscopic and histologic activity will help to clarify the controversially discussed relationship between PRO and biologic activity [31]. Follow-up information is typically captured once a year.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Cohort Profile: The Swiss Eosinophilic Esophagitis Cohort Study (SEECS)

Safroneeva

Saner²,

Rossel³

et al. 2017

Inflamm Intest Dis

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Background and Aims: The prospective, observational Swiss Eosinophilic Esophagitis Cohort Study (SEECS) was set up in 2015 with the following goals in mind: (1) to provide up-to-date epidemiologic data; (2) to assess the appropriateness of care; (3) to evaluate the psychosocial impact; and (4) to foster translational research projects. Data capture relies on validated instruments to assess disease activity and focuses on epidemiologic variables and biosamples (esophageal biopsies and blood specimens). An annual inclusion of 70 new patients with eosinophilic esophagitis (EoE) or proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is intended. We herein describe the SEECS cohort profile. Methods: The SEECS includes adult patients (age ≥18 years) with EoE or PPI-REE diagnosed according to published criteria. After inclusion, the patients are typically seen once a year for a clinical and endoscopic/histologic follow-up examination. Data are captured using validated questionnaires. Biosamples from patients with gastroesophageal reflux disease (GERD) and controls with a healthy esophagus are collected as well. Results: From January 2016 to July 2017, a total of 111 patients with EoE and 10 patients with PPI-REE were recruited. In addition, esophageal biopsies and blood samples from 11 patients with GERD and 20 controls with a healthy esophagus were collected. The mean age of the patients with EoE and those with PPI-REE was 39.6 ± 12.9 and 44.6 ± 15.6 years, respectively. A male predominance was found among both the patients with EoE (77.5%) and those with PPI-REE (70%). Concomitant allergic disorders were found in 79.3% of the patients with EoE and 90% of the patients with PPI-REE. At inclusion, the EoE patients were treated with the following therapeutic regimens: no therapy (0.9%), PPI (36%), swallowed topical corticosteroids (82.9%), elimination diets (15.3%), and esophageal dilation (19.8%). Conclusions: The SEECS is the first national cohort study of patients with EoE or PPI-REE. The SEECS will provide up-to-date epidemiologic data and foster translational research projects.

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“…The treatment has been shown to have no effect on the eosinophil counts or other histological aspects of the disease, and symptoms and strictures inevitably return. In addition, a cost analysis model over the course of one year showed an 8% reduction in cost when medical therapy was utilized first over dilation [127].…”

Section: Dilationmentioning

confidence: 99%

Eosinophilic Esophagitis: A Comprehensive Review

Nt¹

2016

J Hepatol Gastroint Dis

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Eosinophilic Esophagitis (EoE) has been the subject of intense research and study over the past few years, as incidence and prevalence has increased in the United States, especially in adults. The signs, symptoms and complications of EoE arise from a complex interplay of genetic predisposition and environmental exposure that is not understood well at this time. The disease causes significant morbidity in both physical and psychological areas, and these effects may become permanent in some cases where remodeling of the epithelium is present. Treatment at this time mainly focuses on diet, medication and endoscopic dilation. While none of these entities can accomplish all of the treatment goals, careful selection of patients based on symptoms and physical findings can alleviate many of the complications of the disease. In addition, this review attempts to cull data from adult studies if possible, as much of the studies that involved children did not translate well to adult patients.

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Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis

Cited by 278 publications

References 35 publications

Systematic review of histological remission criteria in eosinophilic esophagitis

Systematic review of histological remission criteria in eosinophilic esophagitis

Cohort Profile: The Swiss Eosinophilic Esophagitis Cohort Study (SEECS)

Eosinophilic Esophagitis: A Comprehensive Review

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