Background and aims

Updated diagnostic guidelines for eosinophilic esophagitis (EoE) have eliminated the requirement for a proton pump inhibitor (PPI) trial, but there are no models to identify patients with EoE based on these new criteria. We aimed to develop a predictive model for diagnosis of EoE based on the updated EoE diagnostic guidelines.

Methods

We performed a secondary analysis of a prospective study of adult patients referred for outpatient esophagogastroduodenoscopy at University of North Carolina who had symptoms of esophageal dysfunction; patients with prevalent EoE were excluded. We analyzed data from 206 EoE cases (mean age 40.1, 62.6% male, 93.2% white) and 306 controls (mean age 52.3, 37.9% male, 79.7% white). We built predictive models for case-control status, using clinical, endoscopic, and histologic features, and defining EoE by either the new or historical definition of PPI non-response. Model discrimination was assessed by the area under the receiver-operator characteristic curve (AUC).

Results

Before endoscopy, younger age, male sex, history of atopic condition or food allergy, and dysphagia identified patients with EoE with an AUC of 0.83. When we included endoscopy findings suggestive of EoE, the model identified patients with EoE with an AUC of 0.92; this increased to 0.99 when histology was included.

Conclusion

We developed a model to identify patients with EoE, without a trial of PPIs, based on updated diagnostic guidelines. Clinical features and endoscopic findings identified patients with EoE with an AUC of 0.92—even without histologic data and in the absence of dysphagia. This model can be used to select patients with upper gastrointestinal symptoms but without dysphagia for early diagnostic endoscopy. The model can also be used to identify cases of EoE when eosinophil counts are greater than 15 in biopsies but other causes of esophageal eosinophilia cannot necessarily be excluded.

中文翻译：

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使用临床和内窥镜特征的模型根据更新的诊断指南识别有嗜酸性食管炎风险的患者

背景和目标

更新的嗜酸性食管炎 (EoE) 诊断指南取消了对质子泵抑制剂 (PPI) 试验的要求，但没有基于这些新标准识别 EoE 患者的模型。我们的目标是根据更新的 EoE 诊断指南开发用于诊断 EoE 的预测模型。

方法

我们对在北卡罗来纳大学转诊接受食管胃十二指肠镜检查的有食管功能障碍症状的成年患者的前瞻性研究进行了二次分析。排除了普遍存在 EoE 的患者。我们分析了 206 例 EoE 病例（平均年龄 40.1，62.6% 男性，93.2% 白人）和 306 名对照（平均年龄 52.3，37.9% 男性，79.7% 白人）的数据。我们建立了病例对照状态的预测模型，使用临床、内窥镜和组织学特征，并通过 PPI 无应答的新定义或历史定义来定义 EoE。通过接受者-操作者特征曲线 (AUC) 下的面积评估模型区分。

结果

在内窥镜检查之前，年龄较小、男性、特应性疾病或食物过敏史和吞咽困难确定 EoE 患者的 AUC 为 0.83。当我们纳入提示 EoE 的内窥镜检查结果时，该模型确定了 EoE 患者的 AUC 为 0.92；当包括组织学时，该值增加到 0.99。

结论

我们根据更新的诊断指南开发了一个模型来识别 EoE 患者，而无需进行 PPI 试验。临床特征和内镜检查结果确定 EoE 患者的 AUC 为 0.92——即使没有组织学数据且没有吞咽困难。该模型可用于选择有上消化道症状但没有吞咽困难的患者进行早期诊断内窥镜检查。当活检中嗜酸性粒细胞计数大于 15 时，该模型还可用于识别 EoE 病例，但不能排除食管嗜酸性粒细胞增多的其他原因。