Eosinophilic Esophagitis Endoscopic Reference Score Accurately Predicts EoE

Summary and Comment |
April 11, 2016

Eosinophilic Esophagitis Endoscopic Reference Score Accurately Predicts EoE

  1. David A. Johnson, MD

It also shows response to treatment with topical steroids or dietary elimination.

  1. David A. Johnson, MD

The Eosinophilic Esophagitis Endoscopic Reference Score (EREFS) was recently developed to help standardize reporting of endoscopic findings in patients with eosinophilic esophagitis (EoE; Gut 2013; 62:489). The score takes into account the presence of esophageal edema and strictures and the presence and severity of exudates, rings, and furrows.

To assess the diagnostic accuracy of the score and its responsiveness to treatment among patients with EoE, researchers conducted a prospective cohort study of consecutively enrolled adults undergoing outpatient upper endoscopy who had symptoms of esophageal dysfunction. Patients who received a diagnosis of EoE (per consensus guidelines) were then treated with topical steroids or dietary elimination and subsequently underwent a repeat endoscopy.

The mean score was significantly higher among the 67 patients with a diagnosis of EoE compared with the 144 patients without EoE (3.88 vs. 0.42). A cutoff value of 2 optimized the score's diagnostic utility (overall accuracy, 91%; sensitivity, 88%; specificity, 92%; positive-predictive value, 84%; negative-predictive value, 94%). At least one endoscopic feature of EoE was evident in 64 of 67 patients prior to their confirmed diagnoses of EoE.

Among patients who underwent treatment for EoE, the mean total score was lower after treatment (2.01 vs. 3.88; P<0.001) and was lower in those with a histologic response (<15 eosinophils per high-power field) compared with nonresponders (1.08 vs. 3.24; P<0.001). Improvement was observed in each of the five individual score domains except strictures.

Comment

These results confirm that EREFS is highly predictive as well as responsive to treatment. Pending validation among non-experts, endoscopists should become familiar with EREFS to provide consistency in reporting the diagnostic features and assessing response to treatment of EoE.

Editor Disclosures at Time of Publication

  • Disclosures for David A. Johnson, MD at time of publication Consultant / Advisory board Medscape; Pfizer; CRH Medical Corporation; American Board of Internal Medicine; WebMD Equity CRH Medical Corporation Editorial boards Medscape Gastroenterology Leadership positions in professional societies American Board of Internal Medicine (Gastroenterology Examination Board)

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