Optimal Histologic Cutpoints for Treatment Response in Patients With Eosinophilic Esophagitis: Analysis of Data From a Prospective Cohort Study

Abstract

Background and aims: No prospective studies substantiate 15 eos/hpf as an appropriate endpoint for treatment of eosinophilic esophagitis (EoE). We aimed to determine a histologic cutpoint that identifies successful treatment of EoE by assessing symptomatic and endoscopic improvement.

Methods: We performed a prospective cohort study of 62 consecutive adult patients undergoing outpatient esophagogastroduodenoscopy at the University of North Carolina from 2009 through 2014. At diagnosis of EoE and after 8 weeks of standard treatment, symptom and endoscopic responses were measured using a visual analogue scale and an endoscopic severity score (ESS), and eosinophil counts were assessed. Receiver operator curves and logistic regression models evaluated the histologic threshold that best predicted symptomatic and endoscopic response. For symptoms, analysis was limited to patients without baseline esophageal dilation.

Results: The mean eosinophil count at diagnosis was 124 eos/hpf, falling to 35 eos/hpf after treatment. The mean visual analogue scale decreased from 3.4 at baseline to 1.7 after treatment, and the mean ESS decreased from 3 to 1.6. Twenty-nine patients had symptom responses (47%) and 34 had endoscopic responses (55%). Post-treatment eosinophil count thresholds of 8, 15, and 5 eos/hpf best predicted symptom, endoscopic and combined responses, respectively. On logistic regression, decreasing eosinophil count was significantly associated with the probability of symptomatic (P = .01) and endoscopic response (P < .001).

Conclusions: In a prospective study of patients with EoE, we found that a cutpoint of <15 eos/hpf identifies most patients with symptom and endoscopic improvements, providing support for the current diagnostic threshold. A lower threshold (<5 eos/hpf) identifies most patients with a combination of symptom and endoscopic responses; this cutpoint might be used in situations that require a stringent histologic threshold.

Keywords: Corticosteroids; Cutoff Value; Dietary Therapy; Predicted Outcome.

Figure 1.

(A) Endoscopic, symptomatic, and combined response depending on post-treatment eosinophil count thresholds. (B) Endoscopic, symptomatic, and combined response depending on percent change in post-treatment eosinophil counts.

Figure 2.

Frequency of baseline esophageal dilation in symptom responders (defined by a 50% decrease in the VAS), as stratified by histologic response (defined as <15 eos/hpf).

Figure 3.

(A) Predicted probability of symptom response per post-treatment eosinophil count. (B) Predicted probability of endoscopic treatment response per post-treatment eosinophil count. (C) Predicted probability of combined treatment response per post-treatment eosinophil count. (D) Predicted probability of symptom response per percent change in post-treatment eosinophil count. (E) Predicted probability of endoscopic treatment response per percent change in post-treatment eosinophil count. (F) Predicted probability of combined treatment response per percent change in post-treatment eosinophil count.