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Clinical prediction tool recognizes EoE without biopsy
Researchers from the University of North Carolina School of Medicine have validated a set of clinical and endoscopic features that can accurately predict eosinophilic esophagitis without the need for esophageal biopsy.
Evan S. Dellon, MD, MPH, and colleagues performed a prospective study of patients who underwent outpatient upper endoscopy from July 2011 through December 2013 to evaluate the utility of a predictive model using clinical and endoscopic features — but no histological data — in discriminating EoE from non-EoE-related GERD or dysphagia symptoms.
Evan S. Dellon
They enrolled 81 patients with EoE (mean age, 38 years; 60% men; 93% white) and 144 non-EoE controls with either GERD- or dysphagia-predominant symptoms (mean age, 52 years; 38% men; 82% white).
They found clinical features, including age, sex, dysphagia and food allergy, combined with endoscopic features, including rings, furrows, plagues and hiatal hernia, were highly predictive of EoE, with an area under the curve of 0.944 and 84% sensitivity, 97% specificity, 92% accuracy, 93% positive predictive value and 91% negative predictive value. Subgroup analysis of controls with only reflux or dysphagia, or only those with non–EoE-related esophageal eosinophilia, showed the model performed comparably well.
“Using these predictors at the point-of-care to aid with clinical decision making … will avoid the effort and expense of low-yield histological examination for EoE and also provide guidance in cases where differentiating EoE from other conditions is challenging,” the researchers concluded. – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.