title: The changing faces of eosinophilic esophagitis: the impact of consensus guidelines at the University of South Florida.
abstract: OBJECTIVE
  Prior to the consensus guideline conference in 2007, eosinophilic esophagitis (EoE) was uncommon dominated by the fibrostenotic phenotype, but over the past decade has become a common cause of dysphagia with more inflammatory phenotypes diagnosed. We assessed the impact of guideline definitions on the characteristics of EoE phenotypes over the past 26 years at our institution.
  
  
  METHODS
  We reviewed the electronic health record of 75 consecutive patients meeting guideline definition EoE from 1/1988 to 5/2014. We separated groups based on 5-year intervals of diagnosis and phenotype. For continuous data, results were summarized as mean difference and standard deviation with 95 % confidence intervals.
  
  
  RESULTS
  Five groups based on 5-year intervals of diagnosis were identified: group 1-1988-1993 (n = 7), group 2-1994-1999 (n = 7), group 3-2000-2005 (n = 4), group 4-2006-2011 (n = 35), and group 5-2012-2014 (n = 22). Prior to 2000, all patients were diagnosed with fibrostenotic EoE. After the initial 2007 guideline conference, inflammatory EoE has predominated with only one-third diagnosed with fibrostenotic EoE. Prior to 2011, only two were diagnosed with PPI-REE. In the last 3 years, 8 out of 22 patients (32 %) had PPI-REE. Overall, 8 out of 10 (80 %) PPI-REE were the inflammatory phenotype. When comparing pre- (n = 18) and post (n = 57)-consensus definitions, there was a significant difference between age of diagnosis (30.710.2 vs. 41.3 ± 14.3; p = 0.001), age of symptom onset (18.4 +/15.2 vs. 32.4 ± 15.5), and initial esophageal diameter (10.5 ± 2.7 vs. 14.3 ± 4.2; p < 0.0001), respectively.
  
  
  CONCLUSIONS
  Fibrostenotic EoE has steadily decreased, and inflammatory EoE is now the most recognized form. Across our 26-year experience, there was a decrease in delay in diagnosis and severity of esophageal stricture. The pivotal change occurred around 2007 corresponding to the first EoE guideline emphasizing the impact and importance of early detection of disease.
authors.affiliation: Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Lipka
authors.forename: H Worth
authors.initials: HW
authors.lastname: Boyce
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.forename: Joel E
authors.initials: JE
authors.lastname: Richter
mesh_terms: D000328:Adult; D000367:Age Factors; D001706:Biopsy; D057765:Eosinophilic Esophagitis / Q000453:epidemiology / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D010641:Phenotype; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies