Subscribe to RSS
DOI: 10.1055/a-1855-1974
Eosinophilic esophagitis: Comparison of clinical, endoscopic and histological scoring systems
Eosinophile Ösophagitis: Vergleich klinischer, endoskopischer und histologischer Scoringsysteme
Abstract
Background Eosinophilic Esophagitis (EoE) has received increasing attention as a disease entity, and it is now recognized as an important disorder of the Upper Gastrointestinal Tract. Topical corticosteroids (tCS) are effective in clinical-pathological remission induction (RI) and remission maintenance (RM) of active EoE. With scoring systems, such as clinical (SDI), endoscopic (EREFS), and histological (EoEHSS) systems, EoE can be graded, and its disease activity can be assessed.
Objective To discover how closely results within each of the three scoring systems SDI, EREFS, and EoEHSS are correlated between initial diagnosis (ID), RI, and RM, and to determine how well scores from the three systems are intercorrelated at each time point.
Methods Retrospective cohort analysis of patients with active EoE was performed between 2006 and 2020, with follow-up for up to 6 years. SDI, EREFS and EoEHSS scores were recorded at ID, at RI, and in RM. Evaluation employed descriptive statistics, the Friedman test, and Bonferroni-corrected post hoc pairwise comparisons.
Results At RI 29 and at RM 19 EoE patients provided data. Significant correlations were found between EREFS and EoEHSS at RI and in RM. Pairwise comparisons showed significant differences between ID and RI for SDI, for EREFS, and for EoEHSS.
Conclusion The scoring systems tested did not show intercorrelation at ID. Comparison revealed significant differences for SDI, EREFS, and EoEHSS between the systems at ID und RI, but not in RM, during tCS treatment. These results underline the efficacy of tCS (at RI and RM) in the treatment of active EoE.
Zusammenfassung
Hintergrund Die EoE als eigenständige Krankheitsentität gewann in den letzten 2 Jahrzehnten zunehmend an Aufmerksamkeit und etablierte sich seither zu einem wichtigen Krankheitsbild des oberen Gastrointestinaltraktes. Topische Corticosteroide (tCS) sind effektiv in der klinisch-pathologischen Remissionsinduktion (RI) und -erhaltung (RE) bei aktiver EoE. Unter Zuhilfenahme klinischer (SDI), endoskopischer (EREFS) sowie histologischer (EoEHSS) Bewertungssysteme kann die EoE graduiert und ihrer Krankheitsaktivität zugeordnet werden. Wie korrelieren SDI, EREFS und EoEHSS zum Zeitpunkt der Erstdiagnose (ED), nach RI und in RE untereinander sowie im Therapieverlauf?
Methodik Retrospektive Kohortenanalyse von 2006–2020 bei Patienten mit einer aktiven EoE mit Follow-Up-Intervallen bis zu 6 Jahren. Die Erhebung des SDI, EREFS und EoEHSS erfolgte zum Zeitpunkt der ED, nach der RI und in der RE. Die Auswertung erfolgte mittels deskriptiver Statistik, Friedman-Test und Bonferroni-korrigierter Post-hoc-Vergleiche.
Ergebnisse Zum Zeitpunkt der RI konnten bei 29 sowie zur RE 19 EoE-Patienten analysiert werden. Alle EoE-Patienten wurden im Mittel über 13 Wochen bis zur RI bzw. im Mittel über 21 Monate mit tCS bis zur RE behandelt. Signifikante Korrelationen zeigte der EREFS zum EoEHSS bei RI sowie bei RE. Die Paarvergleiche mittels Bonferroni-korrigierter Post-hoc-Tests ergaben signifikante Unterschiede zwischen ED und RI für SDI, EREFS und EoEHSS.
Schlussfolgerungen Die Ergebnisse zeigen, dass bei ED die untersuchten Bewertungssysteme zur Bestimmung der Krankheitsaktivität nicht untereinander korrelieren. Der Vergleich der Bewertungssysteme erbringt signifikante Unterschiede zu den Zeitpunkten ED und RI für SDI, EREFS und EoEHSS, jedoch nicht in der RE unter tCS-Therapie. Diese Ergebnisse unterstreichen die Effektivität der tCS in der RI- und RE-Therapie der aktiven EoE.
Publication History
Received: 19 September 2021
Accepted after revision: 15 April 2022
Article published online:
23 November 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Lucendo AJ, Molina-Infante J, Arias A. et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017; 5: 335-358 DOI: 10.1177/2050640616689525. (PMID: 28507746)
- 2 Dellon ES, Liacouras CA, Molina-Infante J. et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology 2018; 155: 1022-1033.e10 DOI: 10.1053/j.gastro.2018.07.009. (PMID: 30009819)
- 3 Dellon ES, Irani AM, Hill MR. et al. Development and field testing of a novel patient-reported outcome measure of dysphagia in patients with eosinophilic esophagitis. Aliment Pharmacol Ther 2013; 38: 634-642 DOI: 10.1111/apt.12413. (PMID: 23837796)
- 4 Franciosi JP, Hommel KA, Bendo CB. et al. PedsQL eosinophilic esophagitis module: feasibility, reliability, and validity. J Pediatr Gastroenterol Nutr 2013; 57: 57-66 DOI: 10.1097/MPG.0b013e31828f1fd2. (PMID: 23478422)
- 5 Schoepfer AM, Straumann A, Panczak R. et al. Development and validation of a symptom-based activity index for adults with eosinophilic esophagitis. Gastroenterology 2014; 147: 1255-1266.e21 DOI: 10.1053/j.gastro.2014.08.028. (PMID: 25160980)
- 6 Straumann A, Conus S, Degen L. et al. Budesonide is effective in adolescent and adult patients with active eosinophilic esophagitis. Gastroenterology 2010; 139: 1526-1537.e1 DOI: 10.1053/j.gastro.2010.07.048. (PMID: 20682320)
- 7 Hirano I, Moy N, Heckman MG. et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013; 62: 489-495 DOI: 10.1136/gutjnl-2011-301817. (PMID: 22619364)
- 8 van Rhijn BD, Warners MJ, Curvers WL. et al. Evaluating the endoscopic reference score for eosinophilic esophagitis: moderate to substantial intra- and interobserver reliability. Endoscopy 2014; 46: 1049-1055 DOI: 10.1055/s-0034-1377781. (PMID: 25208033)
- 9 Collins MH, Martin LJ, Alexander ES. et al. Newly developed and validated eosinophilic esophagitis histology scoring system and evidence that it outperforms peak eosinophil count for disease diagnosis and monitoring. Dis Esophagus 2017; 30: 1-8 DOI: 10.1111/dote.12470. (PMID: 26857345)
- 10 Warners MJ, Ambarus CA, Bredenoord AJ. et al. Reliability of histologic assessment in patients with eosinophilic oesophagitis. Aliment Pharmacol Ther 2018; 47: 940-950 DOI: 10.1111/apt.14559. (PMID: 29460418)
- 11 Dohil R, Newbury R, Fox L. et al. Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Gastroenterology 2010; 139: 418-429
- 12 Miehlke S, Hruz P, Vieth M. et al. A randomised, double-blind trial comparing budesonide formulations and dosages for short-term treatment of eosinophilic oesophagitis. Gut 2016; 65: 390-399 DOI: 10.1136/gutjnl-2014-308815. (PMID: 25792708)
- 13 Lucendo AJ, Miehlke S, Schlag C. et al. Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology 2019; 157: 74-86.e15
- 14 Andreae DA, Hanna MG, Magid MS. et al. Swallowed Fluticasone Propionate Is an Effective Long-Term Maintenance Therapy for Children With Eosinophilic Esophagitis. Am J Gastroenterol 2016; 111: 1187-1197 DOI: 10.1038/ajg.2016.238. (PMID: 27325220)
- 15 Greuter T, Bussmann C, Safroneeva E. et al. Long-Term Treatment of Eosinophilic Esophagitis With Swallowed Topical Corticosteroids: Development and Evaluation of a Therapeutic Concept. Am J Gastroenterol 2017; 112: 1527-1535 DOI: 10.1038/ajg.2017.202. (PMID: 28719593)
- 16 Oliva S, Rossetti D, Papoff P. et al. A 12-Week Maintenance Therapy with a New Prepared Viscous Budesonide in Pediatric Eosinophilic Esophagitis. Dig Dis Sci 2019; 64: 1571-1578 DOI: 10.1007/s10620-018-5449-x. (PMID: 30659470)
- 17 Straumann A, Lucendo AJ, Miehlke S. et al. Budesonide Orodispersible Tablets Maintain Remission in a Randomized, Placebo-Controlled Trial of Patients With Eosinophilic Esophagitis. Gastroenterology 2020; DOI: 10.1053/j.gastro.2020.07.039.
- 18 Dellon ES, Sheikh A, Speck O. et al. Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis. Gastroenterology 2012; 143: 321-324.e1 DOI: 10.1053/j.gastro.2012.04.049. (PMID: 22561055)
- 19 Kim HP, Vance RB, Shaheen NJ. et al. The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 988-996.e5 DOI: 10.1016/j.cgh.2012.04.019. (PMID: 22610003)
- 20 Safroneeva E, Straumann A, Coslovsky M. et al. Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis. Gastroenterology 2016; 150: 581-590.e4 DOI: 10.1053/j.gastro.2015.11.004. (PMID: 26584601)
- 21 Straumann A, Conus S, Degen L. et al. Long-term budesonide maintenance treatment is partially effective for patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2011; 9: 400-409.e1 DOI: 10.1016/j.cgh.2011.01.017. (PMID: 21277394)
- 22 Muir AB, Merves J, Liacouras CA. Role of Endoscopy in Diagnosis and Management of Pediatric Eosinophilic Esophagitis. Gastrointest Endosc Clin N Am 2016; 26: 187-200 DOI: 10.1016/j.giec.2015.08.006. (PMID: 26616904)
- 23 Bolton SM, Kagalwalla AF, Wechsler JB. Eosinophilic Esophagitis in Children: Endoscopic Findings at Diagnosis and Post-intervention. Curr Gastroenterol Rep 2018; 20: 4 DOI: 10.1007/s11894-018-0607-z. (PMID: 29492720)
- 24 Schoepfer AM, Hirano I, Coslovsky M. et al. Variation in Endoscopic Activity Assessment and Endoscopy Score Validation in Adults With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2019; 17: 1477-1488.e10 DOI: 10.1016/j.cgh.2018.11.032. (PMID: 30476587)
- 25 Hirano I, Collins MH, Assouline-Dayan Y. et al. RPC4046, a Monoclonal Antibody Against IL13, Reduces Histologic and Endoscopic Activity in Patients With Eosinophilic Esophagitis. Gastroenterology 2019; 156: 592-603.e10 DOI: 10.1053/j.gastro.2018.10.051. (PMID: 30395812)
- 26 Dellon ES, Cotton CC, Gebhart JH. et al. Accuracy of the Eosinophilic Esophagitis Endoscopic Reference Score in Diagnosis and Determining Response to Treatment. Clin Gastroenterol Hepatol 2016; 14: 31-39 DOI: 10.1016/j.cgh.2015.08.040. (PMID: 26404868)
- 27 Dellon ES, Katzka DA, Collins MH. et al. Budesonide Oral Suspension Improves Symptomatic, Endoscopic, and Histologic Parameters Compared With Placebo in Patients With Eosinophilic Esophagitis. Gastroenterology 2017; 152: 776-786.e5
- 28 Collins MH, Dellon ES, Katzka DA. et al. Budesonide Oral Suspension Significantly Improves Eosinophilic Esophagitis Histology Scoring System Results: Analyses From a 12-Week, Phase 2, Randomized, Placebo-controlled Trial. Am J Surg Pathol 2019; 43: 1501-1509 DOI: 10.1097/PAS.0000000000001361. (PMID: 31498177)
- 29 Rodriguez-Sanchez J, Barrio-Andres J, Nantes Castillejo O. et al. The Endoscopic Reference Score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis. Aliment Pharmacol Ther 2017; 45: 300-309 DOI: 10.1111/apt.13845. (PMID: 27868216)
- 30 Greuter T, Safroneeva E, Bussmann C. et al. Maintenance Treatment Of Eosinophilic Esophagitis With Swallowed Topical Steroids Alters Disease Course Over A 5-Year Follow-up Period In Adult Patients. Clin Gastroenterol Hepatol 2019; 17: 419-428 e6
- 31 van Rhijn BD, Verheij J, Smout AJ. et al. The Endoscopic Reference Score shows modest accuracy to predict histologic remission in adult patients with eosinophilic esophagitis. Neurogastroenterol Motil 2016; 28: 1714-1722 DOI: 10.1111/nmo.12872. (PMID: 27254480)
- 32 Hiremath G, Correa H, Acra S. et al. Correlation of endoscopic signs and mucosal alterations in children with eosinophilic esophagitis. Gastrointestinal endoscopy 2020; 91: 785-794.e1 DOI: 10.1016/j.gie.2019.11.031. (PMID: 31785273)
- 33 Hirano I, Dellon ES, Hamilton JD. et al. Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis. Gastroenterology 2020; 158: 111-122.e10
- 34 Wechsler JB, Bolton SM, Amsden K. et al. Eosinophilic Esophagitis Reference Score Accurately Identifies Disease Activity and Treatment Effects in Children. Clin Gastroenterol Hepatol 2018; 16: 1056-1063 DOI: 10.1016/j.cgh.2017.12.019. (PMID: 29248734)
- 35 Collins MH, Hirano I, Dellon ES. et al. Sa1151 – Baseline Characteristics and Correlation Between Dysphagia and Disease Activity in Patients with Eosinophilic Esophagitis in a Randomized, Placebo-Controlled, Phase 2 Dupilumab Trial. Gastroenterology 2018; 154: S-259
- 36 Larsson H, Norder Grusell E, Tegtmeyer B. et al. Grade of eosinophilia versus symptoms in patients with dysphagia and esophageal eosinophilia. Dis Esophagus 2016; 29: 971-976 DOI: 10.1111/dote.12417. (PMID: 26390287)
- 37 Hudgens S, Evans C, Phillips E. et al. Psychometric validation of the Dysphagia Symptom Questionnaire in patients with eosinophilic esophagitis treated with budesonide oral suspension. Journal of Patient-Reported Outcomes 2017; 1: 3 DOI: 10.1186/s41687-017-0006-5. (PMID: 29757322)