The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis.
The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis.
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DOI：
10.1016/j.cgh.2012.04.019
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发表时间：
2012-09
影响因子：
12.6
通讯作者：
Dellon, Evan S.
中科院分区：
文献类型：
--
作者：
Kim, Hannah P.;Vance, R. Brooks;Shaheen, Nicholas J.;Dellon, Evan S.
内镜检查结果如食管环、狭窄、食管窄径、线状沟、白色斑块、苍白或血管减少可能提示嗜酸性食管炎（EoE）的存在。我们的目的是确定EoE的患病率和内窥镜特征的诊断效用。我们进行了系统回顾和荟萃分析。检索PubMed、EMBASE和GI会议摘要，以确定纳入≥10例EoE患者并报告内镜检查结果的研究。使用随机和混合效应模型计算合并患病率、敏感性、特异性和预测值。检索得到100篇文章和摘要，涉及4678例EoE患者和2742例非EoE患者（对照组）。在EoE患者中，食道环的总发生率为44%，狭窄21%，窄口径食道9%，线状沟48%，白色斑块27%，苍白/脉管减少41%。研究之间存在大量异质性。17%的患者内窥镜检查结果正常，但当分析仅限于前瞻性研究时，这一数字降至7% （P< 0.05）。总体敏感性水平一般，范围为15%至48%，而特异性水平较高，范围为90%至95%。阳性预测值为51% ~ 73%，阴性预测值为74% ~ 84%。内镜检查在EoE患者中发现的患病率在研究中存在异质性，但在前瞻性研究中，内镜检查在93%的患者中至少发现一种异常。仅凭内镜检查结果的操作特征不足以诊断EoE。所有具有EoE临床特征的患者都应进行食管活检，无论食管的内镜外观如何。
Endoscopic findings such as esophageal rings, strictures, narrow-caliber esophagus, linear furrows, white plaques, and pallor or decreased vasculature might indicate the presence of eosinophilic esophagitis (EoE). We aimed to determine the prevalence and diagnostic utility of endoscopic features of EoE. We conducted a systematic review and meta-analysis. PubMed, EMBASE, and GI meeting abstracts were searched to identify studies that included ≥ 10 patients with EoE and reported endoscopic findings. Pooled prevalence, sensitivity, specificity, and predictive values were calculated using random- and mixed-effects models. The search yielded 100 articles and abstracts on 4678 patients with EoE and 2742 without (controls). In subjects with EoE, the overall pooled prevalence of esophageal rings was 44%, strictures 21%, narrow-caliber esophagus 9%, linear furrows 48%, white plaques 27%, and pallor/decreased vasculature 41%. Substantial heterogeneity existed among studies. Results from endoscopy examinations were normal in 17% of patients, but this number decreased to 7% when the analysis was limited to prospective studies (P<.05). Overall levels of sensitivity were modest, ranging from 15% to 48%, whereas levels of specificity were greater, ranging from 90% to 95%. Positive predictive values ranged from 51% to 73% and negative predictive values ranged from 74% to 84%. There is heterogeneity among studies in the reported prevalence of endoscopic findings in patients with EoE, but in prospective studies, at least 1 abnormality was detected by endoscopy in 93% of patients. The operating characteristics of endoscopic findings alone are inadequate for diagnosis of EoE. Esophageal biopsies should be obtained from all patients with clinical features of EoE, regardless of the endoscopic appearance of the esophagus.
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