EoE Module 7 References-Kim et al Clin Gastroenterol Hepatol 2012 The prevalence and diagnostic utility of endoscopic features of EoE a meta analysis

Kim et al Clin Gastroenterol Hepatol 2012 The prevalence and diagnostic utility of endoscopic features of EoE a meta analysis

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The meta-analysis led by Hannah P. Kim and colleagues investigates the prevalence and diagnostic utility of endoscopic features in patients with Eosinophilic Esophagitis (EoE). EoE is a chronic immune/antigen-mediated esophageal disease characterized by clinical symptoms related to esophageal dysfunction and histological features of eosinophil-predominant inflammation. Diagnostic guidelines traditionally do not highlight endoscopic findings due to their variability and non-specificity.<br /><br />The study reviewed 4678 patients with EoE across 100 relevant articles, pinpointing the prevalence of several endoscopic features: esophageal rings (44%), strictures (21%), narrow-caliber esophagus (9%), linear furrows (48%), white plaques or exudates (27%), and pallor or decreased vasculature (41%). Findings indicated that although endoscopic abnormalities were initially observed in merely 17% of patients, this proportion climbed to 93% in prospective settings—emphasizing improved detection with systematic approaches.<br /><br />Despite high specificity ranging between 90% and 95% across different findings, sensitivity was generally low (15-48%), rendering individual endoscopic features inadequate as standalone diagnostic tools. Positive and negative predictive values varied from 51% to 73% and 74% to 84%, respectively. Although age significantly influenced endoscopic presentations—adults exhibiting more rings and strictures compared to children, who showed more white plaques and vasculature changes—the role of endoscopy alone remains unreliable in EoE diagnosis.<br /><br />The study concludes that esophageal biopsies are essential for any patient presented with symptoms of EoE, irrespective of endoscopic results. These biopsies ensure accurate diagnosis and differentiation from conditions such as proton pump inhibitor-responsive esophageal eosinophilia, thus reinforcing biopsies' roles against the backdrop of heterogenous endoscopic findings. This comprehensive analysis underscores the importance of thorough clinical evaluation supported by histological confirmation for EoE diagnosis.

Keywords

Eosinophilic Esophagitis

endoscopic features

esophageal rings

diagnostic utility

esophageal biopsies

histological confirmation

systematic approaches

clinical evaluation

immune-mediated disease

endoscopy sensitivity