Game Changers in Gastroenterology: 2011

David A. Johnson, MD


November 23, 2011

In This Article

Toward Uniformity in the Diagnosis of Eosinophilic Esophagitis (EoE): The Effect of Guidelines on Variability of Diagnostic Criteria for EoE

Sperry SL, Shaheen NJ, Dellon ES
Am J Gastroenterol. 2011;106:824-832.

Although consensus guidelines for the diagnosis and treatment of eosinophilic esophagitis (EoE) were published in 2007, adherence to these recommendations has not been evaluated. To assess the extent of guideline adoption, 2 investigators independently searched the literature on EoE published from January 1, 2007 to June 30, 2010. Articles were rated as consistent with the 2007 guidelines if all 3 of the following criteria were present:

  • Symptoms of esophageal disease (eg, dysphagia, food impaction, regurgitation, heartburn, chest pain, feeding intolerance, failure to thrive, or nausea/emesis);

  • Histologic cutoff of ≥ 15 eosinophils per high-powered field (≥ 15 eos/hpf); and

  • GERD was excluded as evidenced by failure of high-dose PPI or normal pH monitoring of acid suppressants

Of 149 original articles analyzed, use of recommended EoE diagnostic criteria was higher in those published after the guidelines than before (31% vs 6%; P < .001). Only 24% of all articles explicitly stated that all 3 of the criteria were used to establish the diagnosis of EoE. The percentage of studies using ≥15 eos/hpf as the histologic cut-off point increased from 11% to 46%. Biopsy protocols varied widely, with only 11% following the recommendation to take biopsy samples from multiple esophageal locations, the stomach, and the duodenum.

Why Is This a Game Changer?

Although the consensus guidelines have provided recommendations toward homogeneity in the diagnosis of EoE, most of the literature still reflects a lack of conformity to them.


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