Variability in diagnostic criteria for eosinophilic esophagitis: A systematic review

Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
The American Journal of Gastroenterology (Impact Factor: 9.21). 11/2007; 102(10):2300-13. DOI: 10.1111/j.1572-0241.2007.01396.x
Source: PubMed

ABSTRACT Eosinophilic esophagitis (EoE) is an emerging clinicopathologic entity defined by abnormal esophageal eosinophilic infiltration. Our understanding of this disease is hampered by the lack of a uniform diagnostic standard. The aim of this systematic review was to determine the range of diagnostic strategies and histologic criteria in the EoE literature.
The MEDLINE-indexed literature from 1950 through December 31, 2006 was independently searched by two investigators. To identify additional relevant studies, bibliographies were hand searched, as were the published proceedings of the 2000-2006 American College of Gastroenterology and American Gastroenterological Association national meetings. Data were extracted from all human EoE case reports, case series, cross-sectional and cohort studies, and clinical trials.
Of 318 publications initially identified, 116 original articles, 39 abstracts, and 69 reviews were included. We found 10 different histologic definitions of EoE, ranging from 5 to 30 eosinophils per high-powered field (hpf), though 41 (35%) of the original articles did not state their diagnostic criteria. In the 13 original articles (11%) reporting an hpf area, the eosinophil density per mm(2) varied 23-fold. There was also variation in esophageal biopsy protocols, but specific protocols were reported in just 45 (39%) original articles.
Significant variability in diagnostic criteria for eosinophilic esophagitis exists, and in a large proportion of studies, criteria are not reported. Because of this lack of a common disease definition, conclusions drawn from the cumulative EoE literature should be viewed with caution. A consensus research-quality standard for diagnosis of eosinophilic esophagitis is needed.

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    ABSTRACT: BackgroundEosinophilic esophagitis (EoE) represents a relatively new, rapidly increasing, chronic inflammatory disease of the esophagus. MethodsTo present a review of the recent literature, we performed a PubMed search for eosinophilic esophagitis, pathogenesis, and treatments. ResultsEoE is defined clinicopathologically by esophagus- related symptoms in combination with a dense esophageal eosinophilia, both of which are refractory to treatment with proton pump inhibitors. EoE can affect patients at any age. In adult patients the leading symptom is dysphagia for solids, often leading to food impaction. Children with EoE present mainly with vomiting, thoracic and abdominal pain, and failure to grow. EoE can mimic symptoms and findings associated with gastroesophageal reflux disease. Studies to date suggest an allergy-triggered etiology with an overriding Th2 phenotype. Current treatments include topical and systemic corticosteroids, immunosuppressants, immunomodulators, dilation, and hypoallergic diets. ConclusionsEoE represents a immune-mediated disease of undetermined pathogenesis. Natural history studies as well as prospective therapeutic trials will be critical to defining future treatment strategies.
    Esophagus 12/2008; 5(4):177-183. DOI:10.1007/s10388-008-0172-x · 0.74 Impact Factor
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    ABSTRACT: Eosinophilic esophagitis (EE) is being recognized w i t h i n c r e a s i n g f r e q u e n c y . N u m e r o u s studies have investigated its pathogenesis, pathophysiologic manifestations, and effective diagnosis and treatment methods in recent years. In this article, we will review the recent advances in research on EE.
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