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 O; De Petris, Giovanni; Smyrk, Thomas C; Woosley, John T; Yan, Pu; Yang, Guang-Yu; ... (2016). Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis. Gastroenterology, 150(3), 581-590.e4. Elsevier 10.1053/j.gastro.2015.11.004

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Safroneeva, Ekaterina; Coslovsky, Michael; Zwahlen, Marcel; Kühni, Claudia; Panczak, Radoslaw and Haas, Nadine

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0016-5085

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

26 Jan 2016 09:26

Last Modified:

09 Sep 2017 18:50

Publisher DOI:

10.1053/j.gastro.2015.11.004

PubMed ID:

26584601

Uncontrolled Keywords:

Disease Monitoring EEsAI Endoscopic Grading Remission

BORIS DOI:

10.7892/boris.75628

URI:

https://boris.unibe.ch/id/eprint/75628

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