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DOI: 10.1055/a-1855-1974
Eosinophilic esophagitis: Comparison of clinical, endoscopic and histological scoring systems
Eosinophile Ösophagitis: Vergleich klinischer, endoskopischer und histologischer ScoringsystemeAbstract
Background Eosinophilic Esophagitis (EoE) has received increasing attention as a disease entity, and it is now recognized as an important disorder of the Upper Gastrointestinal Tract. Topical corticosteroids (tCS) are effective in clinical-pathological remission induction (RI) and remission maintenance (RM) of active EoE. With scoring systems, such as clinical (SDI), endoscopic (EREFS), and histological (EoEHSS) systems, EoE can be graded, and its disease activity can be assessed.
Objective To discover how closely results within each of the three scoring systems SDI, EREFS, and EoEHSS are correlated between initial diagnosis (ID), RI, and RM, and to determine how well scores from the three systems are intercorrelated at each time point.
Methods Retrospective cohort analysis of patients with active EoE was performed between 2006 and 2020, with follow-up for up to 6 years. SDI, EREFS and EoEHSS scores were recorded at ID, at RI, and in RM. Evaluation employed descriptive statistics, the Friedman test, and Bonferroni-corrected post hoc pairwise comparisons.
Results At RI 29 and at RM 19 EoE patients provided data. Significant correlations were found between EREFS and EoEHSS at RI and in RM. Pairwise comparisons showed significant differences between ID and RI for SDI, for EREFS, and for EoEHSS.
Conclusion The scoring systems tested did not show intercorrelation at ID. Comparison revealed significant differences for SDI, EREFS, and EoEHSS between the systems at ID und RI, but not in RM, during tCS treatment. These results underline the efficacy of tCS (at RI and RM) in the treatment of active EoE.
Zusammenfassung
Hintergrund Die EoE als eigenständige Krankheitsentität gewann in den letzten 2 Jahrzehnten zunehmend an Aufmerksamkeit und etablierte sich seither zu einem wichtigen Krankheitsbild des oberen Gastrointestinaltraktes. Topische Corticosteroide (tCS) sind effektiv in der klinisch-pathologischen Remissionsinduktion (RI) und -erhaltung (RE) bei aktiver EoE. Unter Zuhilfenahme klinischer (SDI), endoskopischer (EREFS) sowie histologischer (EoEHSS) Bewertungssysteme kann die EoE graduiert und ihrer Krankheitsaktivität zugeordnet werden. Wie korrelieren SDI, EREFS und EoEHSS zum Zeitpunkt der Erstdiagnose (ED), nach RI und in RE untereinander sowie im Therapieverlauf?
Methodik Retrospektive Kohortenanalyse von 2006–2020 bei Patienten mit einer aktiven EoE mit Follow-Up-Intervallen bis zu 6 Jahren. Die Erhebung des SDI, EREFS und EoEHSS erfolgte zum Zeitpunkt der ED, nach der RI und in der RE. Die Auswertung erfolgte mittels deskriptiver Statistik, Friedman-Test und Bonferroni-korrigierter Post-hoc-Vergleiche.
Ergebnisse Zum Zeitpunkt der RI konnten bei 29 sowie zur RE 19 EoE-Patienten analysiert werden. Alle EoE-Patienten wurden im Mittel über 13 Wochen bis zur RI bzw. im Mittel über 21 Monate mit tCS bis zur RE behandelt. Signifikante Korrelationen zeigte der EREFS zum EoEHSS bei RI sowie bei RE. Die Paarvergleiche mittels Bonferroni-korrigierter Post-hoc-Tests ergaben signifikante Unterschiede zwischen ED und RI für SDI, EREFS und EoEHSS.
Schlussfolgerungen Die Ergebnisse zeigen, dass bei ED die untersuchten Bewertungssysteme zur Bestimmung der Krankheitsaktivität nicht untereinander korrelieren. Der Vergleich der Bewertungssysteme erbringt signifikante Unterschiede zu den Zeitpunkten ED und RI für SDI, EREFS und EoEHSS, jedoch nicht in der RE unter tCS-Therapie. Diese Ergebnisse unterstreichen die Effektivität der tCS in der RI- und RE-Therapie der aktiven EoE.
Publication History
Received: 19 September 2021
Accepted after revision: 15 April 2022
Article published online:
23 November 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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