title: Lack of compliance with consensus recommendations on the diagnosis of eosinophilic esophagitis (EoE) in published prevalence studies. A clinical and systematic review.
abstract: OBJECTIVE
  According to consensus recommendations, the presence of esophageal symptoms, >15 eosinophils/high-power field and unresponsiveness to proton pump inhibitors are required for a diagnosis of eosinophilic esophagitis (EoE). Nevertheless, inconsistency in using these guidelines has been reported in recent publications. The objective of this study was to assess compliance with EoE diagnostic guidelines in published studies on EoE prevalence and to evaluate other clinical and methodological parameters.
  
  
  METHODS
  A systematic review was conducted in articles published between 2008 and 2015 on the prevalence of EoE in unselected adults. Studies using EoE diagnostic definitions were judged to be compliant if they included all three components of the definition, partially compliant if they included two and non-compliant if they included one or none. Esophageal biopsy protocol differences and descriptions of patients' characteristics were determined.
  
  
  RESULTS
  Among the 20 studies included, eight were performed in a hospital setting and 12 in the general population. Only 40.0% of studies were compliant, 35.0% were partially compliant and 25.0% were non-compliant with the EoE diagnostic definition guidelines. In 60.0% of the studies a proton pump inhibitor trial was not administered. Only 30.0% adhered to the recommendations in the esophageal biopsy protocol. A lack of description of the history of atopia and endoscopic characteristics was observed in many studies.
  
  
  CONCLUSIONS
  Partial or non-compliance with the EoE diagnostic definition was observed in most of the published prevalence studies after the publication of the first consensus. The results of these studies might be interpreted taking into account this context.
authors: Gastroenterology Service, Department of Internal Medicine, University Hospital 'Dr. José E. González' Medical School, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
authors: Diego
authors: D
authors: García-Compeán
authors: Gastroenterology Service, Department of Internal Medicine, University Hospital 'Dr. José E. González' Medical School, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
authors: Emmanuel Irineo
authors: EI
authors: González-Moreno
authors: Gastroenterology Service, Department of Internal Medicine, University Hospital 'Dr. José E. González' Medical School, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
authors: José Alberto
authors: JA
authors: González-González
authors: Gastroenterology Service, Department of Internal Medicine, University Hospital 'Dr. José E. González' Medical School, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
authors: Omar David
authors: OD
authors: Borjas-Almaguer
authors: Gastroenterology Service, Department of Internal Medicine, University Hospital 'Dr. José E. González' Medical School, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
authors: Héctor Jesus
authors: HJ
authors: Maldonado-Garza
mesh_terms: D006801:Humans; D001706:Biopsy; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D004804:Eosinophils / Q000473:pathology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D007958:Leukocyte Count; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure; D003245:Consensus Statements as Topic
chemical_list: D054328:Proton Pump Inhibitors
keywords: consensus; eosinophilic esophagitis; esophageal eosinophilia; prevalence