@article{387e9871a984400288a5b6f1a46a4992,
title = "Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults with Eosinophilic Esophagitis",
abstract = "Background & Aims It is not clear whether symptoms alone can be used to estimate the biologic activity of eosinophilic esophagitis (EoE). We aimed to evaluate whether symptoms can be used to identify patients with endoscopic and histologic features of remission. Methods Between April 2011 and June 2014, we performed a prospective, observational study and recruited 269 consecutive adults with EoE (67% male; median age, 39 years old) in Switzerland and the United States. Patients first completed the validated symptom-based EoE activity index patient-reported outcome instrument and then underwent esophagogastroduodenoscopy with esophageal biopsy collection. Endoscopic and histologic findings were evaluated with a validated grading system and standardized instrument, respectively. Clinical remission was defined as symptom score <20 (range, 0-100); histologic remission was defined as a peak count of <20 eosinophils/mm2 in a high-power field (corresponds to approximately <5 eosinophils/median high-power field); and endoscopic remission as absence of white exudates, moderate or severe rings, strictures, or combination of furrows and edema. We used receiver operating characteristic analysis to determine the best symptom score cutoff values for detection of remission. Results Of the study subjects, 111 were in clinical remission (41.3%), 79 were in endoscopic remission (29.7%), and 75 were in histologic remission (27.9%). When the symptom score was used as a continuous variable, patients in endoscopic, histologic, and combined (endoscopic and histologic remission) remission were detected with area under the curve values of 0.67, 0.60, and 0.67, respectively. A symptom score of 20 identified patients in endoscopic remission with 65.1% accuracy and histologic remission with 62.1% accuracy; a symptom score of 15 identified patients with both types of remission with 67.7% accuracy. Conclusions In patients with EoE, endoscopic or histologic remission can be identified with only modest accuracy based on symptoms alone. At any given time, physicians cannot rely on lack of symptoms to make assumptions about lack of biologic disease activity in adults with EoE. ClinicalTrials.gov, Number: NCT00939263.",
keywords = "Disease Monitoring, EEsAI, Endoscopic Grading, Remission",
author = "Ekaterina Safroneeva and Alex Straumann and Michael Coslovsky and Marcel Zwahlen and Kuehni, {Claudia E.} and Radoslaw Panczak and Haas, {Nadine A.} and Alexander, {Jeffrey A.} and Dellon, {Evan S.} and Nirmala Gonsalves and Ikuo Hirano and John Leung and Christian Bussmann and Collins, {Margaret H.} and Newbury, {Robert O.} and {De Petris}, Giovanni and Smyrk, {Thomas C.} and Woosley, {John T.} and Pu Yan and Yang, {Guang Yu} and Yvonne Romero and Katzka, {David A.} and Furuta, {Glenn T.} and Gupta, {Sandeep K.} and Aceves, {Seema S.} and Mirna Chehade and Spergel, {Jonathan M.} and Schoepfer, {Alain M.}",
note = "Funding Information: Members of the international EEsAI study group participating in data collection (in alphabetical order): Sami R. Achem (Mayo Clinic, Jacksonville, FL), Amindra S. Arora (Mayo Clinic, Rochester, MN), Oral Alpan (O&O Alpan, LLC, Section on Immunopathogenesis, Fairfax), David Armstrong (McMaster University, Hamilton, Canada), Stephen E. Attwood (North Tyneside Hospital, North Shields, UK), Joseph H. Butterfield (Mayo Clinic, Rochester, MN), Michael D. Crowell (Mayo Clinic, Scottsdale, AZ), Kenneth R. DeVault (Mayo Clinic, Jacksonville, FL), Eric Drouin (CHU Sainte-Justine, Montreal, Canada), Benjamin Enav (Pediatric Gastroenterology of Northern Virginia), Felicity T. Enders (Mayo Clinic, Rochester, MN), David E. Fleischer (Mayo Clinic, Scottsdale, AZ), Amy Foxx-Orenstein (Mayo Clinic, Scottsdale, AZ), Dawn L. Francis (Mayo Clinic, Jacksonville, FL), Gordon H. Guyatt (McMaster University, Hamilton, Canada), Lucinda A. Harris (Mayo Clinic, Scottsdale, AZ), Amir F. Kagalwalla (Northwestern University Feinberg School of Medicine, Chicago), Hirohito Kita (Mayo Clinic, Rochester, MN), Murli Krishna (Mayo Clinic, Jacksonville, FL), James J. Lee (Mayo Clinic, Scottsdale, AZ), John C. Lewis (Mayo Clinic, Scottsdale, AZ), Kaiser Lim (Mayo Clinic, Rochester, MN), G. Richard Locke III (Mayo Clinic, Rochester, MN), Joseph A. Murray (Mayo Clinic, Rochester, MN), Cuong C. Nguyen (Mayo Clinic, Scottsdale, AZ), Diana M. Orbelo (Mayo Clinic, Rochester, MN), Shabana F. Pasha (Mayo Clinic, Scottsdale, AZ), Francisco C. Ramirez (Mayo Clinic, Scottsdale, AZ), Javed Sheikh (Kaiser Permanente Los Angeles Medical Center, Los Angeles), Sarah B. Umar (Mayo Clinic, Scottsdale, AZ), Catherine R. Weiler (Mayo Clinic, Rochester, MN), John M. Wo (Indiana University, Indianapolis), Tsung-Teh Wu (Mayo Clinic, Rochester, MN), Kathleen J. Yost (Mayo Clinic, Rochester, MN). This work was supported by the following grants from the Swiss National Science Foundation (grant no. 32003B_135665/1 to AMS, AS, CK, and MZ and 32003B_160115/1 to AMS), AstraZeneca AG, Switzerland, Aptalis Pharma Inc, Dr Falk Pharma GmbH, Germany, Glaxo Smith Kline AG, Nestl? S.A., Switzerland, Receptos Inc, Regeneron Inc, and The International Gastrointestinal Eosinophil Researchers (TIGER). Publisher Copyright: {\textcopyright} 2016 AGA Institute.",
year = "2016",
month = mar,
day = "1",
doi = "10.1053/j.gastro.2015.11.004",
language = "English (US)",
volume = "150",
pages = "581--590.e4",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "3",
}