Conflicting results have been recently reported for the accuracy of the Endoscopic Reference Score (EREFS), an standardized endoscopic classification, to predict the histological activity of eosinophilic esophagitis.
Dr Rodríguez-Sánchez and colleagues from Spain evaluated the accuracy of the EREFS to predict either histological or clinical activity of eosinophilic esophagitis.
The team conducted a prospective multicenter study in 8 Spanish centers evaluating adult eosinophilic esophagitis patients, either naïve or after treatment.
Symptoms were evaluated before upper endoscopy through the Dysphagia Symptom Score, whereas researchers scored the EREFS immediately after the endoscopic procedure, unaware of the histological outcome.
|No endoscopic feature exceeded 70% accuracy to predict histological activity|
|Alimentary Pharmacology & Therapeutics|
The team included 145 eosinophilic esophagitis patients undergoing 240 consecutive endoscopic procedures.
Exudates, furrows, and a composite score of inflammatory signs accurately predicted histological activity.
The research team found that exudates were the only endoscopic sign showing a good correlation with histological outcome after therapy.
Furrows and edema persisted in 50% and 70% of patients despite histological remission.
No endoscopic feature exceeded 70% accuracy to predict histological activity.
The team noted that no endoscopic finding could adequately predict dysphagia severity.
Crepe paper mucosa, diffuse exudates and severe rings correlated with higher symptom score.
Dr Rodríguez-Sánchez's team concludes, "Endoscopic findings assessed by the Endoscopic Reference Score did not correlate with histological or clinical disease activity in adult eosinophilic esophagitis patients."
"Only exudates correlated with peak eosinophil count and histological outcome, whereas furrows and oedema persisted in over half of patients despite histological remission."