Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Clin Gastroenterol Hepatol. 2018 Feb;16(2):226-233.e2. doi: 10.1016/j.cgh.2017.09.046. Epub 2017 Oct 4.
No prospective studies substantiate 15 eos/hpf as an appropriate endpoint for treatment of eosinophilic esophagitis (EoE). We aimed to determine a histologic cutpoint that identifies successful treatment of EoE by assessing symptomatic and endoscopic improvement.
We performed a prospective cohort study of 62 consecutive adult patients undergoing outpatient esophagogastroduodenoscopy at the University of North Carolina from 2009 through 2014. At diagnosis of EoE and after 8 weeks of standard treatment, symptom and endoscopic responses were measured using a visual analogue scale and an endoscopic severity score (ESS), and eosinophil counts were assessed. Receiver operator curves and logistic regression models evaluated the histologic threshold that best predicted symptomatic and endoscopic response. For symptoms, analysis was limited to patients without baseline esophageal dilation.
The mean eosinophil count at diagnosis was 124 eos/hpf, falling to 35 eos/hpf after treatment. The mean visual analogue scale decreased from 3.4 at baseline to 1.7 after treatment, and the mean ESS decreased from 3 to 1.6. Twenty-nine patients had symptom responses (47%) and 34 had endoscopic responses (55%). Post-treatment eosinophil count thresholds of 8, 15, and 5 eos/hpf best predicted symptom, endoscopic and combined responses, respectively. On logistic regression, decreasing eosinophil count was significantly associated with the probability of symptomatic (P = .01) and endoscopic response (P < .001).
In a prospective study of patients with EoE, we found that a cutpoint of <15 eos/hpf identifies most patients with symptom and endoscopic improvements, providing support for the current diagnostic threshold. A lower threshold (<5 eos/hpf) identifies most patients with a combination of symptom and endoscopic responses; this cutpoint might be used in situations that require a stringent histologic threshold.
尚无前瞻性研究证实每高倍视野 15 个嗜酸性粒细胞（EOS）是嗜酸细胞性食管炎（EoE）治疗的合适终点。本研究旨在通过评估症状和内镜改善情况，确定一个组织学切点来识别 EoE 的治疗成功。
我们对 2009 年至 2014 年期间在北卡罗来纳大学接受门诊食管胃十二指肠镜检查的 62 例连续成人 EoE 患者进行了前瞻性队列研究。在 EoE 诊断时和标准治疗 8 周后，使用视觉模拟量表和内镜严重程度评分（ESS）测量症状和内镜反应，并评估嗜酸性粒细胞计数。接受者操作特征曲线和逻辑回归模型评估了预测症状和内镜反应的最佳组织学阈值。对于症状，分析仅限于基线无食管扩张的患者。
诊断时的平均嗜酸性粒细胞计数为 124 个/高倍视野，治疗后降至 35 个/高倍视野。基线时的平均视觉模拟量表评分从 3.4 降至治疗后的 1.7，平均 ESS 从 3 降至 1.6。29 例患者有症状反应（47%），34 例有内镜反应（55%）。治疗后，嗜酸性粒细胞计数阈值为 8、15 和 5 个/高倍视野分别最佳预测症状、内镜和联合反应。逻辑回归显示，嗜酸性粒细胞计数减少与症状（P =.01）和内镜反应（P <.001）的概率显著相关。
在一项前瞻性 EoE 患者研究中，我们发现，<15 个/高倍视野的切点可识别大多数有症状和内镜改善的患者，为当前的诊断阈值提供了支持。较低的阈值（<5 个/高倍视野）可识别大多数有症状和内镜反应的患者；在需要严格组织学阈值的情况下，该切点可能有用。
