Document Detail


Clinical Features Distinguish Eosinophilic And Reflux-Induced Esophagitis: An Age-Matched, Case-Controlled Study And A Novel Scoring System.
MedLine Citation:
PMID:  23085895     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: Diagnosing eosinophilic esophagitis (EoE) depends on intraepithelial eosinophil count of ≥15 eosinophils per high power field (HPF). However, differentiating EoE from gastroesophageal reflux disease (GERD) continues to be a challenge, as no true 'gold standard' criteria exist. Identifying clinical and endoscopic characteristics that distinguish EoE could provide a more comprehensive diagnostic strategy than the present criteria. OBJECTIVES:: To determine symptoms and signs that can be used to distinguish EoE from reflux esophagitis. METHODS:: Adult and pediatric EoE patients were identified by current diagnostic guidelines including an esophageal biopsy finding of ≥ 15 eosinophils/HPF. GERD patients were age-matched one-to-one to EoE patients. Clinical, endoscopic and histologic information at the time of diagnosis was obtained from the medical record and compared between pairs by McNemar's test. A conditional logistic regression model was created using six distinguishing disease characteristics. This model was used to create a nomogram to differentiate EoE from reflux-induced esophagitis. RESULTS:: Patients with EoE were 75% male and 68% had a history of atopy. Many aspects of EoE were statistically distinct from GERD when controlling for age. Male gender, dysphagia, history of food impaction, absence of pain/heartburn, linear furrowing and white papules were the distinguishing variables used to create the logistic regression model and scoring system based on odds ratios. The area under the curve of the receiver-operator characteristic curve for this model was 0.858. CONCLUSIONS:: EoE can be distinguished from GERD using a scoring system of clinical and endoscopic features. Prospective studies will be needed to validate this model.
Authors:
Daniel J Mulder; David J Hurlbut; Angela J Noble; Christopher J Justinich
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-18
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  -     ISSN:  1536-4801     ISO Abbreviation:  J. Pediatr. Gastroenterol. Nutr.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Department of Anatomy and Cell Biology †Department of Pathology and Molecular Medicine ‡Department of Pediatrics §Departments of Anatomy and Cell Biology, Pediatrics, Physiology and Medicine, Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
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