Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Clin Gastroenterol Hepatol. 2018 May;16(5):664-671.e1. doi: 10.1016/j.cgh.2017.12.020. Epub 2017 Dec 14.
BACKGROUND & AIMS: It is a challenge to make a diagnosis of eosinophilic esophagitis (EoE) because its symptoms and histologic features overlap with those of gastroesophageal reflux disease (GERD). A minimally invasive device was recently developed to detect mucosal impedance (MI) that measures epithelial integrity during upper endoscopy. We aimed to quantify MI along the esophagus and identify patterns that differentiated patients with and without GERD from those with EoE, and determine whether MI values and patterns are sufficient to identify patients with EoE using histologic findings as a reference. METHODS: We performed a retrospective analysis of 91 patients with upper gastrointestinal symptoms referred for diagnostic testing for GERD and EoE from 2012 through 2014 (discovery set). During the first endoscopy, MI measurements were obtained at 2, 5, and 10 cm from the squamocolumnar junction. GERD was confirmed by ambulatory pH tests, and histologic analyses of biopsies were used to confirm EoE. We then used statistical modeling to identify MI patterns along the esophagus (at 10 cm, 5 cm, and 2 cm) that associated with GERD vs EoE. We validated our findings in a prospective cohort of 49 patients undergoing elective upper endoscopy for dysphagia, from 2015 through 2016, testing the ability of MI patterns to identify patients with vs. without EoE. RESULTS: We found patients with EoE to have a unique MI pattern, with low values along the esophageal axis. MI measurements at 5 cm could discern patients with normal vs abnormal mucosa with 83% sensitivity and 79% specificity, and patients with EoE vs GERD with 84% sensitivity and 70% specificity; these measurements differentiated the patient populations with the highest level of accuracy of any of the 6 measurements tested. In the validation study, a rater using the esophageal MI pattern identified patients with EoE with 100% sensitivity and 96% specificity. CONCLUSION: We identified and validated a pattern of MI along the esophagus that can identify patients with EoE vs normal mucosa or GERD with high levels of sensitivity.
背景与目的：由于嗜酸粒细胞性食管炎（EoE）的症状和组织学特征与胃食管反流病（GERD）重叠，因此做出诊断具有挑战性。最近开发了一种微创设备来检测粘膜阻抗（MI），该设备可在上消化道内镜检查期间测量上皮完整性。我们旨在量化食管沿线的 MI，并确定可将 GERD 患者、EoE 患者与 EoE 患者区分开的模式，并确定 MI 值和模式是否足以根据组织学发现作为参考来识别 EoE 患者。
方法：我们对 2012 年至 2014 年期间因 GERD 和 EoE 诊断性检查而接受上消化道症状检查的 91 例患者进行了回顾性分析（发现集）。在第一次内镜检查时，在从鳞柱状交界 2、5 和 10cm 处获得 MI 测量值。通过动态 pH 测试确认 GERD，通过活检的组织学分析确认 EoE。然后，我们使用统计模型来识别与 GERD 与 EoE 相关的食管沿线的 MI 模式（在 10cm、5cm 和 2cm 处）。我们在 2015 年至 2016 年期间进行选择性上消化道内镜检查以治疗吞咽困难的 49 例患者的前瞻性队列中验证了我们的发现，以测试 MI 模式识别 EoE 患者与无 EoE 患者的能力。
结果：我们发现 EoE 患者具有独特的 MI 模式，食管轴线上的数值较低。5cm 处的 MI 测量值可以以 83%的敏感性和 79%的特异性区分正常与异常粘膜，以 84%的敏感性和 70%的特异性区分 EoE 与 GERD；这些测量值以任何 6 种测试中最高的准确度区分了患者人群。在验证研究中，评分者使用食管 MI 模式以 100%的敏感性和 96%的特异性识别出 EoE 患者。
结论：我们确定并验证了一种食管 MI 模式，该模式可以以高灵敏度识别 EoE 患者与正常粘膜或 GERD 患者。
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