Variability in Diagnostic Criteria for Eosinophilic Esophagitis: A Systematic Review

ArticleinThe American Journal of Gastroenterology 102(10):2300-13 · November 2007with18 Reads
DOI: 10.1111/j.1572-0241.2007.01396.x · Source: PubMed
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.
    • "This particular condition was strategically chosen as it is a relatively new condition, where many RCTs on the topic would be expected to have been designed well after the development of COSMIN and CONSORT guidelines. Furthermore, heterogenous disease definition in EoE was identified relatively early on, as being an issue in the EoE literature [15]. In 2007, in order to address some of these concerns, the First International Gastrointestinal Eosinophil Research Symposium (FIGERS) published consensus guidelines to help improve treatment and diagnosis of EoE (Table 1) [16]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Heterogeneity has been noted in the selection and reporting of disease-specific, pediatric outcomes in randomized controlled trials (RCTs). The consequence is invalid results or difficulty comparing results across trials. The primary objective of this systematic review was to assess primary outcome and outcome measure selection and reporting, in pediatric eosinophilic esophagitis (EoE) treatment trials. As secondary objectives, we compared trial disease definition to established concensus guidelines, and the efficacy of current EoE treatments. Methods We searched MEDLINE, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL since 2001. We also searched clinical trial registries (;;; and and references of included studies. We included RCTs of EoE treatment in patients 0–18 years. Two authors independently assessed articles. ResultsEleven studies met inclusion criteria. All identified primary outcomes, however, of 9 unique primary outcomes, only 2 were used in more than one study. In total, 25 unique primary and secondary outcome measures were employed for pediatric EoE treatment trials. Measurement properties and rationale for their selection was rarely provided. Uptake of consensus-based diagnostic criteria was 25 % in trials initiated after 2011. Due to the small number and heterogeneity of studies obtained, no meta-analysis of treatment efficacy could be undertaken. This SR was limited to exclusively pediatric RCTs. Conclusions The results of this study confirm the need for a standardized set of core outcomes that are universally reported in pediatric EoE trials. Consistent disease definition and standardized outcome reporting will facilitate meta-analyses across similar trials and inform future clinical decision-making.Systematic review registration number CRD42013003798
    Full-text · Article · Dec 2016
    • "In some studies, including a meta-analysis of 4,768 patients with EoE, the esophagus was shown to be normal in 10% -17% of patients undergoing EGD. Furthermore, the metaanalysis showed a low sensitivity and variable predictive values for endoscopic findings to diagnose EoE [38,39]. Endoscopic characteristics, therefore, alone are not diagnostic of EoE and biopsies are warranted in cases with and without endoscopic findings. "
    Full-text · Article · Jan 2015 · Biomedical Optics Express
    • "As a label-free scattering contrast-based optical imaging technique that can provide spatial resolutions comparable to histology, OCT is emerging as a promising tool for detecting GI disorders [20, 22, 57]. Due to the variability in EoE diagnostic criteria [58] and the patchy nature of EoE-associated inflammation [56], the additional micro-structural 3D information obtained using a non-invasive in vivo imaging technique such as OCT can be critical in making the correct diagnosis. However, it is necessary to identify the pathological changes associated with EoE that can be visualized using OCT. "
    [Show abstract] [Hide abstract] ABSTRACT: Pre-clinical studies using murine models are critical for understanding the pathophysiological mechanisms underlying immune-mediated disorders such as Eosinophilic esophagitis (EoE). In this study, an optical coherence tomography (OCT) system capable of providing three-dimensional images with axial and transverse resolutions of 5 µm and 10 µm, respectively, was utilized to obtain esophageal images from a murine model of EoE-like disease ex vivo. Structural changes in the esophagus of wild-type (Tslpr(+/+) ) and mutant (Tslpr(-/-) ) mice with EoE-like disease were quantitatively evaluated and food impaction sites in the esophagus of diseased mice were monitored using OCT. Here, the capability of OCT as a label-free imaging tool devoid of tissue-processing artifacts to effectively characterize murine EoE-like disease models has been demonstrated.
    Full-text · Article · Feb 2014
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