This was a prospective cohort study conducted at the University of North Carolina (UNC) between 2009 and 2011. Consecutive adult patients (ages 18–80 years) referred for routine outpatient esophagogastroduodenoscopy (EGD) were recruited from the two UNC GI procedure units. Patients were stratified by indication (dysphagia vs other indications), and enrolled in an approximately 3:1 ratio of dysphagia vs non-dysphagia indications, in order to enrich the study pool for patients with dysphagia. Subjects were excluded if they had a known (prevalent) diagnosis of EoE or a different eosinophilic gastrointestinal disorder (EGID), GI bleeding, active anticoagulation, known esophageal cancer, prior esophageal surgery, known esophageal varices, medical instability or multiple comorbidities precluding enrollment in the clinical opinion of the endoscopist, or inability to read or understand the consent form. Subjects provided informed consent and were enrolled prior to the endoscopy. This study was approved by the UNC Institutional Review Board.
Subjects with a new (incident) diagnosis of EoE met consensus guidelines (1 (link)). Specifically, cases were required to have at least one typical symptom of esophageal dysfunction (for example dysphagia, food impaction, heartburn, or feeding intolerance); at least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsy persisting after an 8 week PPI trial (20–40 mg twice daily of any of the available agents, prescribed at the discretion of the clinician); and other causes of esophageal eosinophilia excluded. While the majority of the EoE group included subjects who were PPI-naïve on their index endoscopy (n = 24), there were patients who were on high-dose PPI for at least 8 weeks at the time of their index endoscopy (n = 17) who did not have pre-PPI endoscopy or histology data available.
Subjects with PPI-REE were required to have at least one typical symptom of esophageal dysfunction (for example dysphagia, food impaction, heartburn, or feeding intolerance); at least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsy; improvement of esophageal eosinophilia to < 15 eos/hpf after an 8 week PPI trial (20–40 mg twice daily of any of the available agents, prescribed at the discretion of the patient’s clinician); and improvement of symptoms by self-report at the time of the repeat endoscopy. By definition, the PPI-REE group included only subjects who were PPI-naïve at the time of their index endoscopy and required follow-up endoscopy after the PPI trial.
Subjects with a new (incident) diagnosis of EoE met consensus guidelines (1 (link)). Specifically, cases were required to have at least one typical symptom of esophageal dysfunction (for example dysphagia, food impaction, heartburn, or feeding intolerance); at least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsy persisting after an 8 week PPI trial (20–40 mg twice daily of any of the available agents, prescribed at the discretion of the clinician); and other causes of esophageal eosinophilia excluded. While the majority of the EoE group included subjects who were PPI-naïve on their index endoscopy (n = 24), there were patients who were on high-dose PPI for at least 8 weeks at the time of their index endoscopy (n = 17) who did not have pre-PPI endoscopy or histology data available.
Subjects with PPI-REE were required to have at least one typical symptom of esophageal dysfunction (for example dysphagia, food impaction, heartburn, or feeding intolerance); at least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsy; improvement of esophageal eosinophilia to < 15 eos/hpf after an 8 week PPI trial (20–40 mg twice daily of any of the available agents, prescribed at the discretion of the patient’s clinician); and improvement of symptoms by self-report at the time of the repeat endoscopy. By definition, the PPI-REE group included only subjects who were PPI-naïve at the time of their index endoscopy and required follow-up endoscopy after the PPI trial.
