Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease - PubMed (original) (raw)

Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease

Evan S Dellon et al. Clin Gastroenterol Hepatol. 2009 Dec.

Abstract

Background & aims: Features of eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) overlap; because they cannot be differentiated on the basis of eosinophil counts alone, it can be a challenge to distinguish these disorders. We aimed to characterize the clinical, endoscopic, and histologic features of EoE and GERD and to identify factors that might be used to differentiate them.

Methods: We performed a retrospective case-control study on data collected from 2000 to 2007. Cases were patients of any age with EoE, as defined by recent consensus guidelines; controls were patients of any age with GERD. Clinical and endoscopic data were collected, and all esophageal biopsy specimens were reassessed by gastrointestinal pathologists. Cases and controls were compared, unconditional logistic regression was performed to develop a model to predict EoE, and receiver operator characteristic curves were constructed.

Results: Data from 151 patients with EoE and 226 with GERD were analyzed. Compared with GERD, features that independently predicted EoE included younger age; symptoms of dysphagia; documented food allergies; observations of esophageal rings, linear furrows, white plaques, or exudates by upper endoscopy; an absence of a hiatal hernia, observed by upper endoscopy; a higher maximum eosinophil count; and the presence of eosinophil degranulation observed in biopsy specimens. The area under the curve for this model was 0.934.

Conclusions: We identified a set of readily available and routinely measured variables that differentiate EoE from GERD. Use of this type of analysis with patients suspected to have EoE might lead to more accurate diagnoses.

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Figures

Figure 1

Figure 1

A: New cases of eosinophilic esophagitis diagnosed by year of the study time frame. Black bars indicate pediatric cases (age < 18) and grey bars indicate adult cases (age ≥ 18). B: Annual incidence rate of EoE over the study time frame, after accounting for procedure volume. The black bar indicates the rate (number of new diagnoses per year) per 1000 EGDs performed. The light grey bar indicates the rate per 1000 esophageal biopsies performed. The dark grey bar indicates the rate per 1000 esophageal biopsies during EGDs performed for an indication of dysphagia.

Figure 1

Figure 1

A: New cases of eosinophilic esophagitis diagnosed by year of the study time frame. Black bars indicate pediatric cases (age < 18) and grey bars indicate adult cases (age ≥ 18). B: Annual incidence rate of EoE over the study time frame, after accounting for procedure volume. The black bar indicates the rate (number of new diagnoses per year) per 1000 EGDs performed. The light grey bar indicates the rate per 1000 esophageal biopsies performed. The dark grey bar indicates the rate per 1000 esophageal biopsies during EGDs performed for an indication of dysphagia.

Figure 2

Figure 2

A: Symptoms in the eosinophilic esophagitis group as stratified by mean age. Non-specific-type symptoms are seen in younger age groups while more “typical” symptoms are seen in the older patients. B: Symptoms in the EoE group as stratified by adult (age ≥ 18 years) or child (age < 18) status. The stars represent significant differences in the prevalence of symptom types between the groups. C: Endoscopic findings in the EoE group as stratified by mean age. Either a normal esophagus or more inflammatory-type findings are reported in younger age groups, while more “classic” or fibrotic findings are seen in older patients. D: Endoscopic findings in the EoE group as stratified by adult or status. The stars represent significant differences in the prevalence of endoscopic findings between the groups.

Figure 2

Figure 2

A: Symptoms in the eosinophilic esophagitis group as stratified by mean age. Non-specific-type symptoms are seen in younger age groups while more “typical” symptoms are seen in the older patients. B: Symptoms in the EoE group as stratified by adult (age ≥ 18 years) or child (age < 18) status. The stars represent significant differences in the prevalence of symptom types between the groups. C: Endoscopic findings in the EoE group as stratified by mean age. Either a normal esophagus or more inflammatory-type findings are reported in younger age groups, while more “classic” or fibrotic findings are seen in older patients. D: Endoscopic findings in the EoE group as stratified by adult or status. The stars represent significant differences in the prevalence of endoscopic findings between the groups.

Figure 2

Figure 2

A: Symptoms in the eosinophilic esophagitis group as stratified by mean age. Non-specific-type symptoms are seen in younger age groups while more “typical” symptoms are seen in the older patients. B: Symptoms in the EoE group as stratified by adult (age ≥ 18 years) or child (age < 18) status. The stars represent significant differences in the prevalence of symptom types between the groups. C: Endoscopic findings in the EoE group as stratified by mean age. Either a normal esophagus or more inflammatory-type findings are reported in younger age groups, while more “classic” or fibrotic findings are seen in older patients. D: Endoscopic findings in the EoE group as stratified by adult or status. The stars represent significant differences in the prevalence of endoscopic findings between the groups.

Figure 2

Figure 2

A: Symptoms in the eosinophilic esophagitis group as stratified by mean age. Non-specific-type symptoms are seen in younger age groups while more “typical” symptoms are seen in the older patients. B: Symptoms in the EoE group as stratified by adult (age ≥ 18 years) or child (age < 18) status. The stars represent significant differences in the prevalence of symptom types between the groups. C: Endoscopic findings in the EoE group as stratified by mean age. Either a normal esophagus or more inflammatory-type findings are reported in younger age groups, while more “classic” or fibrotic findings are seen in older patients. D: Endoscopic findings in the EoE group as stratified by adult or status. The stars represent significant differences in the prevalence of endoscopic findings between the groups.

Figure 3

Figure 3

Receiver operator characteristic (ROC) curve for the final predictive model differentiating EoE from GERD. Variables in the model include: age at biopsy/diagnosis; dysphagia as a symptom; the presence of a documented food allergy; the presence of rings on EGD; the presence of linear furrows on EGD, the presence of white plaques or exudates seen on EGD; the presence of a hiatal hernia on EGD; the maximum eosinophil count; and the presence of eosinophil degranulation on the biopsy specimen.

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