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

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• 作者：Ekaterina Safroneeva¹ ; ^&lowast ; ; Alex Straumann² ; ³ ; ^&lowast ; ; Michael Coslovsky¹ ; Marcel Zwahlen¹ ; Claudia E. Kuehni¹ ; Radoslaw Panczak¹ ; Nadine A. Haas¹ ; Jeffrey A. Alexander⁴ ; Evan S. Dellon⁵ ; Nirmala Gonsalves⁶ ; Ikuo Hirano⁶ ; John Leung⁷ ; Christian Bussmann⁸ ; Margaret H. Collins⁹ ; Robert O. Newbury¹⁰ ; Giovanni De Petris¹¹ ; Thomas C. Smyrk¹² ; John T. Woosley¹³ ; Pu Yan¹⁴ ; Guang-Yu Yang¹⁵ ; Yvonne Romero⁴ ; ¹⁶ ; ¹⁷ ; David A. Katzka⁴ ; Glenn T. Furuta¹⁸ ; Sandeep K. Gupta¹⁹ ; Seema S. Aceves²⁰ ; Mirna Chehade²¹ ; Jonathan M. Spergel²² ; Alain M. Schoepfer²³ ; ^{alain.schoepfer@chuv.ch" class="auth_mail" title="E-mail the corresponding author} ; International Eosinophilic Esophagitis Activity Index Study GroupSami R. Achem ; Amindra S. Arora ; Oral Alpan ; David Armstrong ; Stephen E. Attwood ; Joseph H. Butterfield ; Michael D. Crowell ; Kenneth R. DeVault ; Eric Drouin ; Benjamin Enav ; Felicity T. Enders ; David E. Fleischer ; Amy Foxx-Orenstein ; Dawn L. Francis ; Gordon H. Guyatt ; Lucinda A. Harris ; Amir F. Kagalwalla ; Hirohito Kita ; Murli Krishna ; James J. Lee ; John C. Lewis ; Kaiser Lim ; G. Richard Locke III ; Joseph A. Murray ; Cuong C. Nguyen ; Diana M. Orbelo ; Shabana F. Pasha ; Francisco C. Ramirez ; Javed Sheikh ; Sarah B. Umar ; Catherine R. Weiler ; John M. Wo ; Tsung-Teh Wu ; Kathleen J. Yost
• 关键词：EEsAI ; Remission ; Endoscopic Grading ; Disease Monitoring
• 刊名：Gastroenterology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：150
• 期：3
• 页码：581-590.e4
• 全文大小：827 K

文摘

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/mm² 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.