How do gastroenterologists assess overall activity of eosinophilic esophagitis in adult patients?
OBJECTIVE
There is no "gold standard" for assessing disease activity in patients with eosinophilic esophagitis (EoE). We aimed to compare physicians' judgment of EoE activity with patients' judgment of symptom severity. We also aimed to examine the relative contribution of symptoms as well as endoscopic and histologic findings in shaping physicians' judgment of EoE activity.


METHODS
Six gastroenterologists (all EoE experts) assessed EoE-associated symptoms in adult patients. Patients completed a symptom instrument and provided global assessment of EoE symptom severity (PatGA) (Likert scale: 0 (inactive) to 10 (most active)). Following esophagogastroduodenoscopy with biopsy sampling, gastroenterologists provided a global assessment of EoE activity (PhysGA) (Likert scale from 0 to 10) based on patient history and endoscopic and histologic findings. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms and endoscopic and histologic findings explain variations in PhysGA.


RESULTS
A total of 149 EoE patients were prospectively included (71.8% male, median age at inclusion 38 years, 71.8% with concomitant allergies). A moderate positive correlation between PhysGA and PatGA (rho=0.442, P<0.001) was observed and the mean difference in the Bland-Altman plot was 1.77. Variations in severity of endoscopic findings, symptoms, and histologic findings alone explained 53%, 49%, and 30%, of the variability in PhysGA, respectively. Together, these findings explained 75% of variability in PhysGA.


CONCLUSIONS
Gastroenterologists rate EoE activity mainly on the basis of endoscopic findings and symptoms and, to a lesser extent, on histologic findings.
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois/CHUV, Lausanne, Switzerland.
Alain M
AM
Schoepfer
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Radoslaw
R
Panczak
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Marcel
M
Zwahlen
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Claudia E
CE
Kuehni
1] Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland [2] Clinical Trials Unit Bern, Department of Clinical Research, University of Bern, Bern, Switzerland.
Michael
M
Coslovsky
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Elisabeth
E
Maurer
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Nadine A
NA
Haas
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Jeffrey A
JA
Alexander
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Evan S
ES
Dellon
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Nirmala
N
Gonsalves
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Ikuo
I
Hirano
Food Allergy Center at Tufts Medical Center and Floating Hospital for Children, Division of Allergy and Immunology, Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, Massachusetts, USA.
John
J
Leung
Viollier AG, Basel, Switzerland.
Christian
C
Bussmann
Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Margaret H
MH
Collins
Department of Pathology, Rady Children's Hospital, University of California, San Diego, San Diego, California, USA.
Robert O
RO
Newbury
Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Scottsdale, Arizona, USA.
Giovanni
G
De Petris
Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Thomas C
TC
Smyrk
Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
John T
JT
Woosley
Institut Universitaire de Pathologie de Lausanne, Lausanne, Switzerland.
Pu
P
Yan
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Guang-Yu
GY
Yang
1] Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA [2] Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA [3] GI Outcomes Unit, Mayo Clinic, Rochester, Minnesota, USA.
Yvonne
Y
Romero
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
David A
DA
Katzka
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
Glenn T
GT
Furuta
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana, USA.
Sandeep K
SK
Gupta
Division of Allergy and Immunology, Rady Children's Hospital, University of California, San Diego, San Diego, California, USA.
Seema S
SS
Aceves
Departments of Pediatrics and Medicine, Mount Sinai Center for Eosinophilic Disorders, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Mirna
M
Chehade
Allergy Group, Nutrition and Health Research, Nestlé Research Center, Lausanne, Switzerland.
Carine
C
Blanchard
1] Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland [2] Swiss EoE Research Group, Praxis Römerhof, Olten, Switzerland.
Alex
A
Straumann
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Ekaterina
E
Safroneeva
D000328:Adult; D000704:Analysis of Variance; D059026:Diagnostic Self Evaluation; D016145:Endoscopy, Digestive System / Q000379:methods; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000150:complications*; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D008487:Medical History Taking / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D062072:Patient Acuity; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013557:Switzerland; D063189:Symptom Assessment / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D014481:United States