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Am J Gastroenterol. 2015 Mar;110(3):402-14. doi: 10.1038/ajg.2015.32. Epub 2015 Mar 3.

How do gastroenterologists assess overall activity of eosinophilic esophagitis in adult patients?

Author information

1
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois/CHUV, Lausanne, Switzerland.
2
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
3
1] Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland [2] Clinical Trials Unit Bern, Department of Clinical Research, University of Bern, Bern, Switzerland.
4
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
5
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
6
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
7
Food Allergy Center at Tufts Medical Center and Floating Hospital for Children, Division of Allergy and Immunology, Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, Massachusetts, USA.
8
Viollier AG, Basel, Switzerland.
9
Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
10
Department of Pathology, Rady Children's Hospital, University of California, San Diego, San Diego, California, USA.
11
Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Scottsdale, Arizona, USA.
12
Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
13
Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
14
Institut Universitaire de Pathologie de Lausanne, Lausanne, Switzerland.
15
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
16
1] Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA [2] Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA [3] GI Outcomes Unit, Mayo Clinic, Rochester, Minnesota, USA.
17
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
18
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana, USA.
19
Division of Allergy and Immunology, Rady Children's Hospital, University of California, San Diego, San Diego, California, USA.
20
Departments of Pediatrics and Medicine, Mount Sinai Center for Eosinophilic Disorders, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
21
Allergy Group, Nutrition and Health Research, Nestlé Research Center, Lausanne, Switzerland.
22
1] Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland [2] Swiss EoE Research Group, Praxis Römerhof, Olten, Switzerland.

Abstract

OBJECTIVES:

There is no "gold standard" for assessing disease activity in patients with eosinophilic esophagitis (EoE). We aimed to compare physicians' judgment of EoE activity with patients' judgment of symptom severity. We also aimed to examine the relative contribution of symptoms as well as endoscopic and histologic findings in shaping physicians' judgment of EoE activity.

METHODS:

Six gastroenterologists (all EoE experts) assessed EoE-associated symptoms in adult patients. Patients completed a symptom instrument and provided global assessment of EoE symptom severity (PatGA) (Likert scale: 0 (inactive) to 10 (most active)). Following esophagogastroduodenoscopy with biopsy sampling, gastroenterologists provided a global assessment of EoE activity (PhysGA) (Likert scale from 0 to 10) based on patient history and endoscopic and histologic findings. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms and endoscopic and histologic findings explain variations in PhysGA.

RESULTS:

A total of 149 EoE patients were prospectively included (71.8% male, median age at inclusion 38 years, 71.8% with concomitant allergies). A moderate positive correlation between PhysGA and PatGA (rho=0.442, P<0.001) was observed and the mean difference in the Bland-Altman plot was 1.77. Variations in severity of endoscopic findings, symptoms, and histologic findings alone explained 53%, 49%, and 30%, of the variability in PhysGA, respectively. Together, these findings explained 75% of variability in PhysGA.

CONCLUSIONS:

Gastroenterologists rate EoE activity mainly on the basis of endoscopic findings and symptoms and, to a lesser extent, on histologic findings.

PMID:
25732414
DOI:
10.1038/ajg.2015.32
[Indexed for MEDLINE]

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