Clinical symptom tool that raises the index of suspicion for eosinophilic oesophagitis in adults and drives earlier biopsy for definitive diagnosis
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Clinical symptom tool that raises the index of suspicion for eosinophilic oesophagitis in adults and drives earlier biopsy for definitive diagnosis. / von Arnim, U; Röhl, F-W; Miehlke, S; Jechorek, D; Reinhold, D; Wex, T; Malfertheiner, P.
in: ALIMENT PHARM THER, Jahrgang 45, Nr. 3, 02.2017, S. 417-426.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Clinical symptom tool that raises the index of suspicion for eosinophilic oesophagitis in adults and drives earlier biopsy for definitive diagnosis
AU - von Arnim, U
AU - Röhl, F-W
AU - Miehlke, S
AU - Jechorek, D
AU - Reinhold, D
AU - Wex, T
AU - Malfertheiner, P
N1 - © 2016 John Wiley & Sons Ltd.
PY - 2017/2
Y1 - 2017/2
N2 - BACKGROUND: Eosinophilic oesophagitis (EoE) and gastro-oesophageal reflux disease (GERD) present with overlapping symptomatology and it is challenging to distinguish EoE from GERD clinically before endoscopy.AIM: To investigate the prognostic value of a set of clinical symptoms and laboratory values in patients with EoE and GERD.METHODS: In this prospective, single-centre, observational study, we compared clinical and laboratory data from 202 patients with EoE or GERD (10 relevant characteristics). Those characteristics showing potential significance in a univariate analysis were then included in a multivariate analysis.RESULTS: The set of 10 characteristics (10-marker set) was able to distinguish between EoE and GERD with good reliability (correct assignment, i.e. agreement with subsequent EGD, of 94.4%). Reduction of the set to the six statistically and clinically most relevant markers continued to give good reliability (88.9%), and further stepwise reduction led to four-marker sets comprising history of atopy, history of food impaction, proton pump inhibitor refractory symptoms and either immunoglobulin E or peripheral eosinophilia, with correct assignment rates of 91.3% and 85.1% respectively.CONCLUSIONS: We have developed a simple and easily applicable clinical/laboratory marker set that helps to distinguish EoE from GERD earlier in the treatment course, thus guiding the endoscopist to perform biopsies from the oesophagus to ensure the diagnosis. The application of the scoring system is expected to diagnose EoE earlier and avoiding delay of adequate treatment.
AB - BACKGROUND: Eosinophilic oesophagitis (EoE) and gastro-oesophageal reflux disease (GERD) present with overlapping symptomatology and it is challenging to distinguish EoE from GERD clinically before endoscopy.AIM: To investigate the prognostic value of a set of clinical symptoms and laboratory values in patients with EoE and GERD.METHODS: In this prospective, single-centre, observational study, we compared clinical and laboratory data from 202 patients with EoE or GERD (10 relevant characteristics). Those characteristics showing potential significance in a univariate analysis were then included in a multivariate analysis.RESULTS: The set of 10 characteristics (10-marker set) was able to distinguish between EoE and GERD with good reliability (correct assignment, i.e. agreement with subsequent EGD, of 94.4%). Reduction of the set to the six statistically and clinically most relevant markers continued to give good reliability (88.9%), and further stepwise reduction led to four-marker sets comprising history of atopy, history of food impaction, proton pump inhibitor refractory symptoms and either immunoglobulin E or peripheral eosinophilia, with correct assignment rates of 91.3% and 85.1% respectively.CONCLUSIONS: We have developed a simple and easily applicable clinical/laboratory marker set that helps to distinguish EoE from GERD earlier in the treatment course, thus guiding the endoscopist to perform biopsies from the oesophagus to ensure the diagnosis. The application of the scoring system is expected to diagnose EoE earlier and avoiding delay of adequate treatment.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Biomarkers
KW - Biopsy
KW - Diagnosis, Differential
KW - Early Diagnosis
KW - Endoscopy
KW - Eosinophilic Esophagitis
KW - Female
KW - Gastroesophageal Reflux
KW - Health Status Indicators
KW - Humans
KW - Male
KW - Middle Aged
KW - Proton Pump Inhibitors
KW - Reproducibility of Results
KW - Young Adult
KW - Journal Article
KW - Observational Study
U2 - 10.1111/apt.13869
DO - 10.1111/apt.13869
M3 - SCORING: Journal article
C2 - 27896821
VL - 45
SP - 417
EP - 426
JO - ALIMENT PHARM THER
JF - ALIMENT PHARM THER
SN - 0269-2813
IS - 3
ER -
