Accuracy of the Eosinophilic Esophagitis Endoscopic Reference Score in Diagnosis and Determining Response to Treatment.
Accuracy of the Eosinophilic Esophagitis Endoscopic Reference Score in Diagnosis and Determining Response to Treatment.
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DOI：
10.1016/j.cgh.2015.08.040
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发表时间：
2016-01
期刊：
影响因子：
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通讯作者：
Shaheen NJ
中科院分区：
文献类型：
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作者：
Dellon ES;Cotton CC;Gebhart JH;Higgins LL;Beitia R;Woosley JT;Shaheen NJ
关于嗜酸性食管炎(EoE)内镜参考评分(EREFS)的诊断效用，以及评分对治疗的反应如何变化，人们知之甚少。我们探讨了EREFS在EOE诊断中的操作特点，评分如何随治疗而变化，以及如何优化评分系统。我们对2011年8月至2013年12月在北卡罗来纳医学院接受门诊上消化道内窥镜检查的成年人进行了一项前瞻性研究。发生EoE的病例根据共识指南诊断，并接受局部类固醇或饮食消除治疗(n=67)；144名未发生EoE的受试者作为对照。比较病例组和对照组的EREFS评分。对EoE患者进行治疗前后的评分比较。用受试者特征曲线下面积(AUC)分析来确定EREFS系统的诊断价值。进行迭代分析以确定最佳EREFS评分权重。EoE患者的平均总EREFS评分为3.88分，对照组为0.42分(P>；.001)；该评分识别EoE患者的AUC为0.934。治疗后EoE患者的平均评分从3.88降至2.01(P&gT；.001)。与无反应的患者相比，有组织学反应的患者这种变化更为显著(降至15Eos/HPF)；治疗后有反应的患者得分为0.45，无反应的患者为3.24(P<；.001)。渗出、环状和水肿评分加倍的加权评分系统最大限度地提高了EREFS总评分的反应性。EREFS分类系统识别EOE患者的AUC为0.934；该评分随着治疗的进行而降低，组织学响应者的评分明显低于无响应者。因此，该系统可用于识别EOE患者，并将其用作跟踪治疗反应的内窥镜结果指标。
Little is known about the diagnostic utility of the eosinophilic esophagitis (EoE) endoscopic reference score (EREFS), and how scores change in response to treatment. We investigated the operating characteristics of the EREFS in diagnosis of EoE, how the score changes with treatment, and ways to optimize scoring system. We performed a prospective study of adults undergoing outpatient upper endoscopy from August 2011 through December 2013 at the North Carolina School of Medicine. Incident cases of EoE were diagnosed per consensus guidelines and were treated with topical steroids or dietary elimination (n=67); 144 subjects without EoE were included as controls. EREFS scores were compared between cases and controls. For EoE cases, scores were compared before and after treatment. Area under the receiver operator characteristic curve (AUC) analysis was used to determine diagnostic utility of the EREFS system. An iterative analysis was performed to determine optimal EREFS scoring weights. The mean total EREFS score was 3.88 for EoE cases and 0.42 for controls (P>.001); the score identified subjects with EoE with an AUC of 0.934. After treatment of EoE cases, the mean score decreased from 3.88 to 2.01 (P>.001). This change was more prominent for patients with a histologic response (reduction to <15 eos/hpf), compared with non-responders; post-treatment scores were 0.45 for responders vs 3.24 for non-responders (P<.001). A weighted scoring system that doubled exudates, rings, and edema scores maximized the responsiveness of the total EREFS score. The EREFS classification system identifies patients with EoE an AUC of 0.934; the score decreases with treatment, and histologic responders have significantly lower scores than non-responders. This system can therefore be used to identify individuals with EoE and used as an endoscopic outcome measure to follow their response to treatment.