Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 1;117(3):413-423.
doi: 10.14309/ajg.0000000000001625.

Prospective Endoscopic Activity Assessment for Eosinophilic Gastritis in a Multisite Cohort

Ikuo Hirano  1 , Margaret H Collins  2 , Eileen King  3 , Qin Sun  3 , Mirna Chehade  4 , J Pablo Abonia  3   5 , Peter A Bonis  6 , Kelly E Capocelli  7 , Evan S Dellon  8 , Gary W Falk  9 , Nirmala Gonsalves  1 , Sandeep K Gupta  10 , John Leung  6 , David Katzka  11 , Paul Menard-Katcher  12 , Paneez Khoury  13 , Amy Klion  14 , Vincent A Mukkada  15 , Kathryn Peterson  15 , Tetsuo Shoda  5 , Amanda K Rudman-Spergel  16 , Jonathan A Spergel  17 , Guang-Yu Yang  1   18 , Marc E Rothenberg  3   5 , Seema S Aceves  19 , Glenn T Furuta  7 ; CEGIR investigators
Affiliations

Prospective Endoscopic Activity Assessment for Eosinophilic Gastritis in a Multisite Cohort

Ikuo Hirano et al. Am J Gastroenterol. .

Abstract

Introduction: Eosinophilic gastritis (EG) is a chronic inflammatory disease of the stomach characterized by eosinophil-predominant gastric mucosal inflammation and gastrointestinal symptoms. The aim of this study was to prospectively evaluate endoscopic features in a large series of children and adults with EG to better understand the endoscopic manifestations and develop a standardized instrument for investigations.

Methods: Data were prospectively collected as part of the Consortium for Eosinophilic Gastrointestinal Disease Researchers, a national collaborative network. Endoscopic features were prospectively recorded using a system specifically developed for EG, the EG Endoscopic Reference System (EG-REFS). Correlations were made between EG-REFS and clinical and histologic features.

Results: Of 98 patients with EG, 65 underwent assessments using EG-REFS. The most common findings were erythema (72%), raised lesions (49%), erosions (46%), and granularity (35%); only 8% of patients with active histology (≥30 eosinophils/high-power field) exhibited no endoscopic findings. A strong correlation between EG-REFS scores and physician global assessment of endoscopy severity was demonstrated (Spearman r = 0.84, P < 0.0001). The overall score and specific components of EG-REFS were more common in the antrum than in the fundus or body. EG-REFS severity was significantly correlated with active histology, defined by a threshold of ≥30 eosinophils/high-power field (P = 0.0002).

Discussion: Prospective application of EG-REFS identified gastric features with a strong correlation with physician global assessment of endoscopic activity in EG. Endoscopic features demonstrated greater severity in patients with active histology and a predilection for the gastric antrum. Further development of EG-REFS should improve its utility in clinical studies.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Classification and severity assessment of endoscopically identified, gastric features of eosinophilic gastritis that include erosion/ulceration (A), granularity (B), raised lesions/nodules (C), erythema (D), thickened folds (E), and friability (F). Pyloric stenosis was also included as a feature but is not depicted.
Figure 1.
Figure 1.
Classification and severity assessment of endoscopically identified, gastric features of eosinophilic gastritis that include erosion/ulceration (A), granularity (B), raised lesions/nodules (C), erythema (D), thickened folds (E), and friability (F). Pyloric stenosis was also included as a feature but is not depicted.
Figure 1.
Figure 1.
Classification and severity assessment of endoscopically identified, gastric features of eosinophilic gastritis that include erosion/ulceration (A), granularity (B), raised lesions/nodules (C), erythema (D), thickened folds (E), and friability (F). Pyloric stenosis was also included as a feature but is not depicted.
Figure 1.
Figure 1.
Classification and severity assessment of endoscopically identified, gastric features of eosinophilic gastritis that include erosion/ulceration (A), granularity (B), raised lesions/nodules (C), erythema (D), thickened folds (E), and friability (F). Pyloric stenosis was also included as a feature but is not depicted.
Figure 1.
Figure 1.
Classification and severity assessment of endoscopically identified, gastric features of eosinophilic gastritis that include erosion/ulceration (A), granularity (B), raised lesions/nodules (C), erythema (D), thickened folds (E), and friability (F). Pyloric stenosis was also included as a feature but is not depicted.
Figure 2.
Figure 2.
Prevalence of specific endoscopic features of EG-REFS. Erythema was the most commonly identified gastric abnormality followed by raised nodules and erosion/ulceration. The prevalence and severity assessment may have been affected by the active use of medical or dietary therapies in most patients.
Figure 3.
Figure 3.
Endoscopic activity of eosinophilic gastritis measured by the composite EG-REFS strongly correlates with physician global assessment of endoscopic severity. (Spearman correlation r 0.84, P<0.0001)
Figure 4.
Figure 4.
Endoscopic activity of eosinophilic gastritis measured by EG-REFS based on region of the stomach. Pairwise comparisons demonstrated significant differences in EG-REFS scores between the antrum, body and fundus with significantly greatest severity in the antrum (P<0.001).
Figure 5.
Figure 5.
Endoscopic activity of eosinophilic gastritis measured by the composite EG-REFS shows modest correlation with disease duration (Spearman correlation 0.48, P<0.001)
See this image and copyright information in PMC

References

    1. Pesek RD, Reed CC, Muir AB, et al. Increasing Rates of Diagnosis, Substantial Co-Occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis, and Colitis Based on 10-Year Data Across a Multicenter Consortium. Am J Gastroenterol. Apr 16 2019;doi:10.14309/ajg.0000000000000228 - DOI - PMC - PubMed
    1. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database. J Pediatr Gastroenterol Nutr. Jan 2016;62(1):36–42. doi:10.1097/MPG.0000000000000865 - DOI - PMC - PubMed
    1. Ko HM, Morotti RA, Yershov O, Chehade M. Eosinophilic gastritis in children: clinicopathological correlation, disease course, and response to therapy. Am J Gastroenterol. Aug 2014;109(8):1277–85. doi:10.1038/ajg.2014.166 - DOI - PubMed
    1. Reed C, Woosley JT, Dellon ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis. Dig Liver Dis. Mar 2015;47(3):197–201. doi:10.1016/j.dld.2014.11.009 - DOI - PMC - PubMed
    1. Kinoshita Y, Furuta K, Ishimaura N, et al. Clinical characteristics of Japanese patients with eosinophilic esophagitis and eosinophilic gastroenteritis. J Gastroenterol. Mar 2013;48(3):333–9. doi:10.1007/s00535-012-0640-x - DOI - PubMed

Publication types

Supplementary concepts