Infectious Colitis

UEG Poster

Standard Poster

Log in to access this content.

Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Introduction

Endoscopy abnormalities of eosinophilic esophagitis (EoE) are currently graded based on the EoE endoscopic reference score (EREFS) ranging 0 to 9. Research has shown that esophageal biopsies are often omitted in Europe in patients reporting dysphagia when the upper endoscopy (EGD) shows no abnormalities [1]. However, a proportion of patients with eosinophilic esophagitis (EoE) may have normal endoscopy (i.e., EREFS=0), making the diagnosis more difficult and increasing the risk of diagnostic delay.

Aims & Methods

We investigated predictors of a diagnosis of EoE when the EGD is unremarkable (i.e., EREFS=0). Consecutive adult patients (≥18 years) with dysphagia who had EREFS=0 at an EGD with six esophageal biopsies were prospectively enrolled. All patients underwent EGD while off any eosinophil-depleting treatment. EoE with EREFS=0 was diagnosed based on the presence of at least 15 eosinophils/high-power field in at least one of six esophageal biopsies. When all six esophageal biopsies showed <15 eosinophils/high-power field, patients were diagnosed with non-EoE dysphagia (NED). Demographics, diagnostic delay (i.e., interval time between symptoms onset and diagnosis), esophageal symptoms, and atopic comorbidities (i.e., allergic rhinitis, asthma, eczema) were collected for all patients. Pearson's Chi-squared test and Fisher's exact test were used for comparisons. Odds ratios (ORs) were calculated to quantify associations between disease states. Significance threshold was set at p<0.05.

Results

Of 133 included patients, 51 (38%) had NED, while 82 (62%) had EoE with EREFS=0. Patients with EoE were more commonly males (67% vs 35%; p<0.001) and younger (37 vs 46 years; p=0.005) compared to patients with NED. Patients with EoE were diagnosed with a significantly longer diagnostic delay than NED (28 vs 4 months; p<0.001). Heartburn, regurgitation, chest pain and dyspepsia had similar prevalence in the two groups. In contrast, patients with EoE had a significantly higher prevalence of atopic comorbidities compared to NED (83% vs 39%; p<0.001).
The presence of rhinitis, diagnostic delay longer than 12 months, any atopic comorbidity, age younger than 37 years, and male sex were associated with an increased risk of EoE with OR of 47.0, 11.6, 7.4, 3.8, and 3.7, respectively (p<0.01 for all).

Conclusion

EoE remains a possible diagnosis in patients reporting dysphagia even when endoscopy is normal. The presence of rhinitis and longer diagnostic delay, the presence of any atopic comorbidity, and younger age are associated with a diagnosis of EoE and are helpful to raise the suspicion of EoE and prompt endoscopists to collect esophageal biopsies.

Characteristic	NED (Non-EoE dysphagia) with EREFS 0 N = 51 (38%)	EoE with EREFS 0, N = 82 (62%)	p-value	Odds Ratio
Sex (Male/total)	18 / 51 (35%)	55 / 82 (67%)	<0.001	3.7 (IQR, 1.6 - 8.3)
Age at diagnosis	46 (40, 58)	37 (28, 50)	<0.01	3.8 (IQR, 1.4 - 10.8)
Diagnostic delay(months)	4 (1, 10)	28 (10, 90)	<0.001	11.6 (IQR, 3.8 - 40.8)
Atopy	20 / 51 (39%)	68 / 82 (83%)	<0.001	7.4 (IQR, 3.1 - 18.2)
Rhinitis	3 / 51 (5.9%)	62 / 82 (76%)	<0.001	47.6 (IQR, 13.2-264.1)

References

[1] Tourlamain, G., Garcia-Puig, R., Gutiérrez-Junquera, C., Papadopoulou, A., Roma, E., Kalach, N., Oudshoorn, J., Sokollik, C., Karolewska-Bochenek, K., Oliva, S., Strisciuglio, C., Bauraind, O., Auth, M. K., Thomson, M., Otte, S., Rok, O., Dias, J. A., Tzivinikos, C., Urbonas, V., Kostovski, A., … ESPGHAN EGID Working group (2020). Differences in Management of Eosinophilic Esophagitis in Europe: An Assessment of Current Practice. Journal of pediatric gastroenterology and nutrition, 71(1), 83–90. https://doi.org/10.1097/MPG.0000000000002672

PREDICTORS OF EOSINIPHILIC ESOPHAGITIS IN PATIENTS WITH DYSPHAGIA AND NORMAL ENDOSCOPY

Filippo Ovidi 1, Pierfrancesco Visaggi 1, Irene Solinas 1, Emanuele Marciano 2, Jason M. Dunn 3, Terence Wong 3, Edoardo Vincenzo Savarino 4, Nicola de Bortoli 1, Sebastian S. Zeki 3

1 Gastroenterology Unit, University of Pisa, Pisa, Italy

2 Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

3 St Thomas' Hospital, London, United Kingdom

4 University of Padua, Division of Gastroenterology, Padua, Italy

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

Upper functional GI disorders: From basic to clinical (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024