Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis.
Details
Serval ID
serval:BIB_882AE15E33FE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis.
Journal
Gastroenterology
Working group(s)
International Eosinophilic Esophagitis Activity Index Study Group
Contributor(s)
Achem SR., Arora AS., Alpan O., Armstrong D., Attwood SE., Butterfield JH., Crowell MD., DeVault KR., Drouin E., Enav B., Enders FT., Fleischer DE., Foxx-Orenstein A., Francis DL., Guyatt GH., Harris LA., Kagalwalla AF., Kita H., Krishna M., Lee JJ., Lewis JC., Lim K., Locke GR.<Suffix>3rd</Suffix> , Murray JA., Nguyen CC., Orbelo DM., Pasha SF., Ramirez FC., Sheikh J., Umar SB., Weiler CR., Wo JM., Wu TT., Yost KJ.
ISSN
1528-0012 (Electronic)
ISSN-L
0016-5085
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
150
Number
3
Pages
581-590.e4
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
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.
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.
Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Area Under Curve, Biopsy, Eosinophilic Esophagitis/complications, Eosinophilic Esophagitis/diagnosis, Eosinophils/pathology, Esophagoscopy, Female, Humans, Leukocyte Count, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, ROC Curve, Remission Induction, Reproducibility of Results, Severity of Illness Index, Surveys and Questionnaires, Switzerland, Treatment Outcome, United States, Young Adult
Pubmed
Web of science
Create date
11/03/2016 9:51
Last modification date
20/08/2019 14:47
Usage data
