title: The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis.
abstract: OBJECTIVE
  Endoscopic findings such as esophageal rings, strictures, narrow-caliber esophagus, linear furrows, white plaques, and pallor or decreased vasculature might indicate the presence of eosinophilic esophagitis (EoE). We aimed to determine the prevalence and diagnostic utility of endoscopic features of EoE.
  
  
  METHODS
  We conducted a systematic review and meta-analysis. PubMed, EMBASE, and gastrointestinal meeting abstracts were searched to identify studies that included more than 10 patients with EoE and reported endoscopic findings. Pooled prevalence, sensitivity, specificity, and predictive values were calculated using random- and mixed-effects models.
  
  
  RESULTS
  The search yielded 100 articles and abstracts on 4678 patients with EoE and 2742 without (controls). In subjects with EoE, the overall pooled prevalence was as follows: esophageal rings, 44%; strictures, 21%; narrow-caliber esophagus, 9%; linear furrows, 48%; white plaques, 27%; and pallor/decreased vasculature, 41%. Substantial heterogeneity existed among studies. Results from endoscopy examinations were normal in 17% of patients, but this number decreased to 7% when the analysis was limited to prospective studies (P < .05). Overall levels of sensitivity were modest, ranging from 15% to 48%, whereas levels of specificity were greater, ranging from 90% to 95%. Positive predictive values ranged from 51% to 73% and negative predictive values ranged from 74% to 84%.
  
  
  CONCLUSIONS
  There is heterogeneity among studies in the reported prevalence of endoscopic findings in patients with EoE, but in prospective studies at least 1 abnormality was detected by endoscopy in 93% of patients. The operating characteristics of endoscopic findings alone are inadequate for diagnosis of EoE. Esophageal biopsy specimens should be obtained from all patients with clinical features of EoE, regardless of the endoscopic appearance of the esophagus.
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
authors.forename: Hannah P
authors.initials: HP
authors.lastname: Kim
authors.forename: R Brooks
authors.initials: RB
authors.lastname: Vance
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
mesh_terms: D001706:Biopsy; D016145:Endoscopy, Digestive System / Q000379:methods*; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity