title: Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis.
abstract: OBJECTIVE
  It is not clear whether symptoms alone can be used to estimate the biologic activity of eosinophilic esophagitis (EoE). We aimed to evaluate whether symptoms can be used to identify patients with endoscopic and histologic features of remission.
  
  
  METHODS
  Between April 2011 and June 2014, we performed a prospective, observational study and recruited 269 consecutive adults with EoE (67% male; median age, 39 years old) in Switzerland and the United States. Patients first completed the validated symptom-based EoE activity index patient-reported outcome instrument and then underwent esophagogastroduodenoscopy with esophageal biopsy collection. Endoscopic and histologic findings were evaluated with a validated grading system and standardized instrument, respectively. Clinical remission was defined as symptom score <20 (range, 0-100); histologic remission was defined as a peak count of <20 eosinophils/mm(2) in a high-power field (corresponds to approximately <5 eosinophils/median high-power field); and endoscopic remission as absence of white exudates, moderate or severe rings, strictures, or combination of furrows and edema. We used receiver operating characteristic analysis to determine the best symptom score cutoff values for detection of remission.
  
  
  RESULTS
  Of the study subjects, 111 were in clinical remission (41.3%), 79 were in endoscopic remission (29.7%), and 75 were in histologic remission (27.9%). When the symptom score was used as a continuous variable, patients in endoscopic, histologic, and combined (endoscopic and histologic remission) remission were detected with area under the curve values of 0.67, 0.60, and 0.67, respectively. A symptom score of 20 identified patients in endoscopic remission with 65.1% accuracy and histologic remission with 62.1% accuracy; a symptom score of 15 identified patients with both types of remission with 67.7% accuracy.
  
  
  CONCLUSIONS
  In patients with EoE, endoscopic or histologic remission can be identified with only modest accuracy based on symptoms alone. At any given time, physicians cannot rely on lack of symptoms to make assumptions about lack of biologic disease activity in adults with EoE. ClinicalTrials.gov, Number: NCT00939263.
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Safroneeva
authors.affiliation: Swiss EoE Research Group, Praxis Römerhof, Olten, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland.
authors.forename: Alex
authors.initials: A
authors.lastname: Straumann
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Coslovsky
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Zwahlen
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Kuehni
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Panczak
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Nadine A
authors.initials: NA
authors.lastname: Haas
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Gonsalves
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hirano
authors.affiliation: 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.
authors.forename: John
authors.initials: J
authors.lastname: Leung
authors.affiliation: Viollier AG, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Bussmann
authors.affiliation: Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Collins
authors.affiliation: Department of Pathology, Rady Children's Hospital, University of California, San Diego, San Diego, California.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Newbury
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Scottsdale, Arizona.
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Petris
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: John T
authors.initials: JT
authors.lastname: Woosley
authors.affiliation: Institut Universitaire de Pathologie de Lausanne, Lausanne, Switzerland.
authors.forename: Pu
authors.initials: P
authors.lastname: Yan
authors.affiliation: Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Yang
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota; GI Outcomes Unit, Mayo Clinic, Rochester, Minnesota.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Romero
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Furuta
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Gupta
authors.affiliation: Division of Allergy and Immunology, Rady Children's Hospital, University of California, San Diego, San Diego, California.
authors.forename: Seema S
authors.initials: SS
authors.lastname: Aceves
authors.affiliation: 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.
authors.forename: Mirna
authors.initials: M
authors.lastname: Chehade
authors.affiliation: Divisions of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spergel
authors.affiliation: Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. Electronic address: alain.schoepfer@chuv.ch.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001706:Biopsy; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D004804:Eosinophils / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012074:Remission Induction; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013557:Switzerland; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Disease Monitoring; EEsAI; Endoscopic Grading; Remission