Differentiation of PPI-Responsive Esophageal Eosinophilia and Eosinophilic Esophagitis by Endoscopic signs.

Warners, M. (Marijn) (2014) Differentiation of PPI-Responsive Esophageal Eosinophilia and Eosinophilic Esophagitis by Endoscopic signs. thesis, Medicine.

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Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic antigen mediated disease histological characterized by eosinophil-predominant inflammation. Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a new terminology for EoE patients who respond to PPI treatment, this group accounts for one-third of patients with esophageal eosinophilia. If we could predict the response to PPI treatment based on endoscopic signs presented at baseline endoscopy (rings, white exudates, furrows, edema, crepe paper esophagus and strictures), patients would be spared from unnecessary additional endoscopies to assess response to treatment. We aimed to determine which endoscopic signs could distinguish PPI-REE from EoE. Methods: High-quality endoscopic images of 30 adult EoE and 30 adult PPI-REE patients were included in this study. Baseline characteristics were collected and compared between groups. If patients showed complete clinical remission after a PPI trial for ≥ 8 weeks they were classified as PPI-REE. Per patient, ≥3 depersonalised images were incorporated in a slideshow and scored by 2 experienced endoscopists, a validated classification system was used. EoE and PPI-REE were statistically compared by a Chi-square and Mann-Whitney U test. Results: Baseline characteristics were highly comparable between EoE and PPI-REE patients (age 35.2 ± 11.9 vs. 39.9 ± 14.3 years, 33% vs. 13% female, Caucasian race 96% vs 82%, atopia 89% each, eos/hpf 35 (20 – 75) vs 30 (20-90)). Endoscopic signs at diagnostic endoscopy did not differ significantly between groups (rings p=0.893, white exudates p=0.209, furrows p=0.696, edema p=0.828, crepepaper esophagus p=1.000 and stricture p=0.071). Conclusion: Based on endoscopic signs at baseline endoscopy EoE and PPI-REE cannot be distinguished before a PPI trial. Demographic and clinical characteristics did not differ between groups. Patients should undergo an additional endoscopy to evaluate histological response to PPI treatment.

Item Type:	Thesis (Thesis)
Supervisor name:	Dullemen, Dhr. Van
Supervisor name:	Rhijn, Drs. B.D. van and Bredenoord, Dr. A.J. and Afd. Maag Darm en Lever-ziekten AMC
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:47
Last Modified:	25 Jun 2020 10:47
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/827

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