title: How to improve the diagnosis of eosinophilic esophagitis: Experience from a case series in Mexico.
abstract: BACKGROUND
  Eosinophilic esophagitis (EoE) is a chronic, immune disorder mediated largely by food antigens. It shares nonspecific symptoms with gastroesophageal reflux disease (GERD). EoE is rarely reported in Mexico, perhaps due to the racial characteristics of the population or because of insufficient diagnostic suspicion.
  
  
  OBJECTIVE
  Our aim was to describe a Mexican cohort with EoE and evaluate the usefulness of the clinical history and endoscopy in the EoE diagnosis, in comparison with GERD patients.
  
  
  METHODS
  A retrospective study was carried out on the clinical characteristics and endoscopic and histopathologic findings in patients with EoE, along with a case-control study on patients with GERD. The endoscopic images obtained were interpreted in a blind and randomized manner by 4 gastroenterologists, before and after providing them with information on the characteristic alterations of EoE. The esophageal biopsies were also blinded to 2 pathologists that evaluated their diagnostic correlation. The Fisher's exact test and Mann-Whitney U test were used in the statistical analysis.
  
  
  RESULTS
  Fourteen patients with EoE were included in the study. Ten (71%) of them were men and the mean age of the patients was 35 years. There were more subjects with a personal history of asthma (p=0.0023) and food impaction (p=0.04) in the EoE group. The initial evaluation of the endoscopic findings showed 53% correct EoE interpretations and rose to 96% in the second revision (sensitivity 100%, specificity 71%, PPV 65%, NPV 100%).
  
  
  CONCLUSIONS
  Mexican patients with EoE have similar characteristics to those of patients in western case series. Clinical awareness of the disorder increases endoscopic diagnosis in up to 40% of cases.
authors.affiliation: Departamento de Gastroenterología y Endoscopia Gastrointestinal, Hospital Ángeles Pedregal, Ciudad de México, México.
authors.forename: R
authors.initials: R
authors.lastname: Soto-Solís
authors.affiliation: Departamento de Gastroenterología y Endoscopia Gastrointestinal, Hospital Ángeles Pedregal, Ciudad de México, México.
authors.forename: K
authors.initials: K
authors.lastname: Santana-de Anda
authors.affiliation: Departamento de Gastroenterología y Endoscopia Gastrointestinal, Hospital Ángeles Pedregal, Ciudad de México, México.
authors.forename: N
authors.initials: N
authors.lastname: González-Uribe
authors.affiliation: Departamento de Patología, Hospital Ángeles Pedregal, Ciudad de México, México.
authors.forename: C
authors.initials: C
authors.lastname: Gallegos
authors.affiliation: Departamento de Patología, Hospital Ángeles Pedregal, Ciudad de México, México.
authors.forename: C
authors.initials: C
authors.lastname: Romo-Aguirre
authors.affiliation: Instituto de Investigaciones Médico Biológicas de la Universidad Veracruzana, Veracruz, México.
authors.forename: J M
authors.initials: JM
authors.lastname: Remes-Troche
authors.affiliation: Departamento de Gastroenterología y Endoscopia Gastrointestinal, Hospital Ángeles Pedregal, Ciudad de México, México. Electronic address: maballamo@yahoo.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Ballesteros-Amozurrutia
mesh_terms: D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008800:Mexico; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
keywords: Disfagia; Dolor torácico no cardiaco; Dysphagia; Eosinophilic esophagitis; Esofagitis eosinofílica; Food impaction; Gastroesophageal reflux; Impactación alimentaria; Noncardiac chest pain; Reflujo gastroesofágico