EoE ToT Module 4 References-Cotton et al Clin Gastroenterol Hepatol 2021 A model using clinical and endoscopic characteristics identifies patients at risk for EoE

Cotton et al Clin Gastroenterol Hepatol 2021 A model using clinical and endoscopic characteristics identifies patients at risk for EoE

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The study, conducted by researchers at the University of North Carolina, develops a predictive model to diagnose eosinophilic esophagitis (EoE) based on updated guidelines that no longer require a proton pump inhibitor (PPI) trial. The analysis involved 206 EoE cases and 306 controls, using clinical, endoscopic, and histologic features. The model was assessed using the area under the receiver-operator characteristic curve (AUC) for its discrimination ability.<br /><br />Key findings include:<br />- Before endoscopy: Younger age, male sex, history of atopic conditions or food allergy, and dysphagia predicted EoE with an AUC of 0.83.<br />- Adding endoscopic findings: The model's AUC increased to 0.92.<br />- Including histologic data: The AUC reached 0.99.<br /><br />The results suggest that clinical and endoscopic features alone can identify EoE with high accuracy under the new guidelines, enabling early diagnostic endoscopy for patients with upper gastrointestinal symptoms, even if they lack dysphagia.<br /><br />The research highlights significant changes in the diagnostic criteria for EoE. Historically, the diagnosis relied on a trial of PPIs, distinguishing EoE from gastroesophageal reflux disease (GERD). However, recent guidelines recognize patients who respond to PPIs as having a similar clinical profile to those with EoE, leading to the elimination of the PPI trial as a diagnostic criterion.<br /><br />The predictive model benefits clinicians by targeting patients at high risk for EoE, aiding in early diagnosis and intervention. This model is particularly valuable for those with upper GI symptoms but lacking classic signs of dysphagia, who might otherwise be overlooked.<br /><br />In summary, the study provides a robust predictive model for diagnosing EoE efficiently, following the updated guidelines, ensuring patients receive appropriate and timely care.

Keywords

Eosinophilic Esophagitis

Predictive Model

University of North Carolina

Proton Pump Inhibitor

Clinical Features

Endoscopic Findings

Histologic Data

Diagnostic Criteria

Upper Gastrointestinal Symptoms

Early Diagnosis