Determination of a Treatment Response Threshold for the Eosinophilic Esophagitis Endoscopic Reference Score

Endoscopy ◽  
2021 ◽  
Author(s):  
Cary C. Cotton ◽  
John T. Woosley ◽  
Susie E. Moist ◽  
Sarah J. McGee ◽  
Alina Iuga ◽  
...  
Keyword(s):  
Treatment Response ◽  
Eosinophilic Esophagitis ◽  
Secondary Analysis ◽  
Topical Steroid ◽  
Mixture Modeling ◽  
Response Threshold ◽  
Confidence Limits ◽  
Response Class ◽  
High Power Field ◽  
Histologic Response

Background and study aims: While endoscopic features of eosinophilic esophagitis (EoE) are measured using the validated EoE Endoscopic Reference Score (EREFS), a threshold for treatment response has not been defined. We aimed to determine a cut-point for endoscopic response as measured by EREFS. Patients and Methods: We performed a secondary analysis of a randomized clinical trial comparing budesonide slurry to swallowed fluticasone multidose inhaler for initial treatment of EoE. In the parent trial, EREFS was determined before and after treatment (score range 0-9), as were histologic findings and dysphagia symptoms. We performed tabular, flexible trend, and dependent mixture analyses of measures of treatment response to select the best clinical EREFS threshold. Results: In the 111 included subjects (mean age 39 years; 67% male; 96% white), an EREFS threshold of ≤2 was 80% sensitive (95% confidence limits 69 - 88%) and 83% specific (95% confidence limits 67 - 94%) for histologic response (peak of <15 eosinophils per high-power field). Flexible trend analysis and dependent mixture modeling similarly suggested a threshold of ≤2 best captured the correlation of EREFS with histologic and symptomatic measures. Dependent mixture modeling found near total membership in the response class at EREFS of 0 or 1 and >75% at EREFS of 2 or 3. Conclusions: An EREFS of ≤2 was the best clinical threshold for endoscopic response to topical steroid treatment and was consistent with clinical and histologic response. Therefore, future studies can report a binary outcome of endoscopic response when EREFS is two or less.

Clinical and Molecular Predictors of Histologic Response to Topical Steroid Treatment in Eosinophilic Esophagitis: Results from a Prospective Study

2017 ◽  
Vol 152 (5) ◽  
pp. S858 ◽  
Author(s):  
Swathi Eluri ◽  
Sara R. Selitsky ◽  
Joel S. Parker ◽  
Johnathan Hollyfield ◽  
Irina Perjar ◽  
...  
Keyword(s):  
Prospective Study ◽  
Eosinophilic Esophagitis ◽  
Topical Steroid ◽  
Steroid Treatment ◽  
Histologic Response ◽  
A Prospective Study

scholarly journals Utility of major basic protein, eotaxin-3, and mast cell tryptase staining for prediction of response to topical steroid treatment in eosinophilic esophagitis: analysis of a randomized, double-blind, double dummy clinical trial

2020 ◽  
Vol 33 (6) ◽  
Author(s):  
Evan S Dellon ◽  
John T Woosley ◽  
Sarah J McGee ◽  
Susan E Moist ◽  
Nicholas J Shaheen
Keyword(s):  
Mast Cell ◽  
Randomized Trial ◽  
Eosinophilic Esophagitis ◽  
Basic Protein ◽  
Topical Steroid ◽  
Inflammatory Factors ◽  
Topical Steroids ◽  
Major Basic Protein ◽  
Mast Cell Tryptase ◽  
Histologic Response

Summary Inflammatory factors in eosinophilic esophagitis (EoE), including major basic protein (MBP), eotaxin-3 (EOT3) and mast cell tryptase (TRP), may predict treatment response to topical corticosteroids (tCS). We aimed to determine whether baseline levels of these markers predict response to tCS for EoE. To do this, we analyzed data from a randomized trial comparing two topical steroids for treatment of newly diagnosed EoE (NCT02019758). A pretreatment esophageal biopsy was stained for MBP, EOT3, and TRP to quantify tissue biomarker levels (cells/mm2). Levels were compared between histologic responders (&lt;15 eos/hpf) and nonresponders (the primary outcome), and endoscopic responders (EREFS&lt;2) and nonresponders. Complete histologic response (&lt;1 eos/hpf) was also assessed, and area under the receiver operator characteristic curve (AUC) was calculated. We also evaluated whether baseline staining predicted symptom relapse in the trial’s off-treatment observation phase. Baseline samples were evaluable in 110/111 subjects who completed the randomized trial. MBP levels were higher in nonresponders (n = 36) than responders (704 vs. 373 cells/mm2; P = 0.007), but EOT3 and TRP levels were not statistically different. The combination of all three stains had an AUC of 0.66 to predict response. For complete histologic response, baseline TRP levels were higher in nonresponders (n = 69) than responders (370 vs. 268 mast cells/mm2; P = 0.01), with an AUC of 0.65. The AUC for endoscopic response was 0.68. Baseline staining did not predict symptom recurrence after remission. Pretreatment MBP, EOT3, and TRP levels were not strongly or consistently associated with histologic or endoscopic response to topical steroids. While elevated TRP levels may be associated with nonresponse compared with complete response, the magnitude and predictive utilities were modest. Novel methods for predicting steroid response are still required.

scholarly journals Clinical and Molecular Factors Associated With Histologic Response to Topical Steroid Treatment in Patients With Eosinophilic Esophagitis

2019 ◽  
Vol 17 (6) ◽  
pp. 1081-1088.e2 ◽  
Author(s):  
Swathi Eluri ◽  
Sara R. Selitsky ◽  
Irina Perjar ◽  
Johnathan Hollyfield ◽  
Renee Betancourt ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Topical Steroid ◽  
Steroid Treatment ◽  
Histologic Response ◽  
Factors Associated

224 A RETROSPECTIVE CASE–CONTROL STUDY ASSESSING THE CLINICAL AND ENDOSCOPIC CHARACTERISTICS OF EOSINOPHILIC ESOPHAGITIS IN JAPAN

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Kazumi Imamura ◽  
Ken Haruma ◽  
Hiroshi Matsumoto ◽  
Yasuhiko Maruyama ◽  
Maki Ayaki ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Japanese Population ◽  
Case Control Study ◽  
High Power Field ◽  
Retrospective Case ◽  
Male Predominance ◽  
Endoscopic Findings ◽  
History Of ◽  
Endoscopic Characteristics ◽  
Control Study

Abstract   Eosinophilic esophagitis (EoE) is an allergy-associated clinicopathologic condition gaining an increasing amount of recognition in various areas of the world. While the clinical definition and characteristics may differ depending on country and region, sufficient studies have not yet been performed in Japan. To assess the prevalence of EoE among the Japanese population and the clinical features and the prognosis associated with the disease. Methods Medical data from January 2012 to October 2018 was gathered from nine Japanese clinical institutes. EoE, defined as more than 15 intraepithelial eosinophils per high power field, was determined based on esophageal biopsies. Clinical and endoscopic patterns in the cases with EoE were investigated and compared with 186 age- and sex-matched controls. We also analyzed the treatment and prognosis of an individual patient. Results From 130,013 upper endoscopic examinations, 66 cases of EoE were identified (0.051%; mean age: 45.2 years (range 7-79); 45 males). Patients with EoE had more symptoms (69.7 vs. 10.8%; P &lt; 0.01) such as dysphagia and food impaction, and more allergies (63.6 vs. 23.7%; P &lt; 0.01) compared with the controls. The prevalence of atrophic gastritis was lower in EoE patients than in the controls (20.0% vs. 33.3%). In 55 patients analyzed, 32 patients (78.0%) received proton pump inhibitors with or without swallowed topical corticosteroids. During the follw-up period (mean 23 months), no patient got worse regarding clinical and endoscopic findings. Conclusion The prevalence of EoE in the Japanese population was 0.051% which was comparable with previous reports in Japan. Male predominance, a history of allergies, and the absence of Helicobacter pylori infection might be risk factors for EoE. Our study also indicated that the prognosis of EoE might be relatively good in Japanese populations.

Eosinophilic esophagitis and achalasia – just a coincidence?

2019 ◽  
Vol 57 (02) ◽  
pp. 151-155 ◽  
Author(s):  
Thomas Frieling ◽  
Jürgen Heise ◽  
Christian Kreysel ◽  
Michael Blank ◽  
Bernhard Hemmerlein ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Esophageal Achalasia ◽  
Eosinophilic Infiltration ◽  
Barium Swallow ◽  
Pneumatic Dilation ◽  
Noncardiac Chest Pain ◽  
High Power Field ◽  
Eckardt Score ◽  
Impedance Testing ◽  
Diagnostic Work

Abstract Background Eosinophilic esophagitis (EoE) is detected frequently in dysphagia and noncardiac chest pain. Management of patients with EoE may be complicated because EoE is associated frequently with esophageal motility disorders. We present the rare case of esophageal achalasia (EA) associated with eosinophilic infiltration and a literature review. Material and methods A patient with dysphagia and eosinophilic infiltration referred to our clinic underwent standardized diagnostic work-up including symptom questionnaire, esophagogastroduodenoscopy (EGD) with esophageal biopsies, barium swallow, high-resolution esophageal manometry, and combined intraluminal 24-hour pH-impedance testing (pH/MII). Results The patient had an Eckardt score of 8. EGD and mucosal biopsies showed typical EoE with > 15 eosinophil leucocytes per high-power field. Barium swallow revealed typical sign of achalasia. HREM indicated EA type 2 according to the Chicago classification. PH/MII was normal. Oral and systemic corticoid therapy were without effect. After successful treatment by pneumatic dilation of the cardia, symptoms relieved and eosinophilic infiltration returned to normal. Conclusion The results suggest that the patient had primary EA associated with eosinophilic infiltration and that the combined occurrence of these rare diseases is not just a coincidence.

scholarly journals Association between endoscopic findings of eosinophilic esophagitis and responsiveness to proton pump inhibitors

2019 ◽  
Vol 07 (04) ◽  
pp. E433-E439 ◽  
Author(s):  
Akinari Sawada ◽  
Atsushi Hashimoto ◽  
Risa Uemura ◽  
Koji Otani ◽  
Fumio Tanaka ◽  
...  
Keyword(s):  
Proton Pump ◽  
Eosinophilic Esophagitis ◽  
Acid Reflux ◽  
Diffuse Type ◽  
High Power Field ◽  
Lower Esophagus ◽  
Small Areas ◽  
Endoscopic Findings ◽  
Esophageal Eosinophilia ◽  
Asymptomatic Patients

Abstract Background and study aims Endoscopic findings of esophageal eosinophilia sometimes localize to small areas of the esophagus. A previous study suggested that pathogenesis of localized-type eosinophilic esophagitis (LEoE) was associated with acid reflux. However, LEoE treatment outcomes have not been studied. We aimed to analyze the clinical and histologic significance of LEoE in comparison with diffuse-type eosinophilic esophagitis (DEoE). Patients and methods This study included 106 patients with esophageal eosinophilia. Esophageal eosinophilia was defined as a condition where the maximum number of intraepithelial eosinophils was ≥ 15 per high-power field. LEoE was defined as an endoscopic lesion confined to one-third of the esophagus: upper, middle, or lower. Esophageal eosinophilia encompassing more than two-thirds of the esophagus was defined as DEoE. We retrospectively compared LEoE and DEoE in terms of clinical characteristics, histologic findings, and proportion of proton pump inhibitor (PPI) responders. Results Of 106 patients, 12 were classified as having LEoE and 94 were classified as having DEoE. The proportion of asymptomatic patients was significantly higher in the LEoE group than the DEoE group (42 % vs 7 %, P < 0.01). In the LEoE group, 10 patients (84 %) had endoscopic lesions in the lower esophagus. The maximum number of eosinophils did not differ between the groups (54 [24 – 71] for LEoE, 40 [20 – 75] for DEoE, P = 0.65). The prevalence of PPI responders was significantly higher in the LEoE group than the DEoE group (100 % vs 63 %, P = 0.01). Conclusion LEoE can be a sign of good responsiveness to PPI therapy.

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