title: Clinical features distinguish eosinophilic and reflux-induced esophagitis.
abstract: OBJECTIVE
  Diagnosing eosinophilic esophagitis (EoE) depends on intraepithelial eosinophil count of ≥15 eosinophils per high-power field (HPF); however, differentiating EoE from gastroesophageal reflux disease (GERD) continues to be a challenge because no true "criterion standard" criteria exist. Identifying clinical and endoscopic characteristics that distinguish EoE could provide a more comprehensive diagnostic strategy than the present criteria. The aim of the study was to determine symptoms and signs that can be used to distinguish EoE from reflux esophagitis.
  
  
  METHODS
  Adult and pediatric patients with EoE were identified by present diagnostic guidelines including an esophageal biopsy finding of ≥15 eosinophils/HPF. Patients with GERD were age-matched one to one with patients with EoE. Clinical, endoscopic, and histologic information at the time of diagnosis was obtained from the medical record and compared between pairs by McNemar test. A conditional logistic regression model was created using 6 distinguishing disease characteristics. This model was used to create a nomogram to differentiate EoE from reflux-induced esophagitis.
  
  
  RESULTS
  Patients with EoE were 75% men and 68% had a history of atopy. Many aspects of EoE were statistically distinct from GERD when controlling for age. Male sex, dysphagia, history of food impaction, absence of pain/heartburn, linear furrowing, and white papules were the distinguishing variables used to create the logistic regression model and scoring system based on odds ratios. The area under the curve of the receiver-operator characteristic curve for this model was 0.858.
  
  
  CONCLUSIONS
  EoE can be distinguished from GERD using a scoring system of clinical and endoscopic features. Prospective studies will be needed to validate this model.
authors.affiliation: Department of Anatomy and Cell Biology, Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Mulder
authors.forename: David J
authors.initials: DJ
authors.lastname: Hurlbut
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Noble
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Justinich
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D057286:Electronic Health Records; D020776:Endoscopes, Gastrointestinal; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D004947:Esophagus / Q000276:immunology / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006356:Heartburn / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D010858:Pigmentation; D017410:Practice Guidelines as Topic; D012372:ROC Curve; D012189:Retrospective Studies; D017678:Sex Distribution; D013499:Surface Properties