A Predictive Score for the Presence of Eosinophils in the Esophagus

Abstract

M O N D A Y 631 A Predictive Score for the Presence of Eosinophils in the Esophagus Margaret Redmond, MD, Jean Brown, MD, Dale Rhoda, Wei Wang, John Russo, MD, Thomas Platts-Mills, MD, PhD, FAAAAI, FRS, Elizabeth Erwin, MD; Nationwide Children’s Hospital, Columbus, OH, University of South Florida, Tampa, FL, University of Virginia, Charlottesville, VA. RATIONALE: Eosinophilic esophagitis (EoE) is a clinicopathologic diagnosis that weighs heavily on having >15 eosinophils per high power field (hpf) on esophageal biopsy. Our objective was to define clinical features that could be used to predict the diagnosis of EoE reducing the need for esophageal biopsy. METHODS: We reviewed 442 medical records for pediatric patients having esophageal biopsy. Using data on demographics, symptoms, and laboratory results, we performed multivariate logistic regression using complete data from 360 charts. RESULTS: We found that there were four independent predictors for the presence of any eosinophils on esophageal biopsyfemale gender [odds ratio (OR) 0.45, p50.004], having food stuck (OR 6.0, P50.001), the absence of diarrhea (OR 0.40, p50.003), and weighted peripheral blood eosinophil count. Using these parameters for the group of patients we studied, sensitivity and specificity for having eosinophils in the esophagus were 0.18 and 0.97 respectively. The area under the ROC curve was 0.72. For 60 patients, serum specific IgE to foods was available. By univariate analysis, specific IgE to milk >0.35 IU/ml, was associated with EoE (OR 5.7, p50.008). Only having peripheral blood eosinophil count >600/mm3 seemed to have a slight effect on having low eosinophils compared with >15 eos/hpf (OR 3.5, p50.05). CONCLUSIONS: The high specificity we found suggests that in patients with a negative biopsy result, our test model is likely to be negative. There was little clinical evidence in our model to support a distinction between low esophageal eosinophils and >15 eosinophils/hpf.