S1094 Limited Accuracy of Upper GI Studies in the Diagnosis of Eosinophilic Esophagitis in Adults

Abstract

INTRODUCTION: Endoscopy (EGD) has high sensitivity and specificity in the diagnosis of eosinophilic esophagitis (EoE). Prior case series in EoE have detected abnormalities on upper GI studies (UGI) but the sensitivity of these findings is unknown. AIM: Evaluate the accuracy of UGI in the diagnosis of EoE and compare UGI findings with EGD features. METHODS: A single center adult EoE database identified patients (pts) with prior UGI. Initial UGI reports, EGD data and unblinded, re-evaluation of UGI images by a senior GI radiologist were compared. RESULTS: From 419 EoE pts, 59 (14%) pts with UGI were analyzed. EoE pts with UGI included 36 males with mean age of 40 years. UGI indications included: dysphagia (80%), known diagnosis of EoE (15%) and miscellaneous (abdominal pain and anemia;5%). Mean time between UGI and EGD was 56 days, excluding 13 pts with > 1.5 years between studies. Initial UGI results were classified into 5 categories: normal (15%), findings characteristic of EoE (rings/furrows/exudates; 0%), findings possibly consistent with EoE (stricture/barium tablet retention; 36%), features consistent with GERD (28%), and miscellaneous (hiatal hernia/Schatzki ring/tertiary contractions; 20%). EGD detected characteristic EoE abnormalities in 85% of pts. On re-evaluation of UGI studies by a radiologist, the detection rate of EoE features improved; however the sensitivity for rings and furrows was lower than EGD (Figure, *p<0.05). UGI re-evaluation demonstrated: normal (4%), characteristics of EoE (41%), possibly consistent with EoE (13%), GERD (26%), and miscellaneous (15%). Strictures were detected by UGI in 47% compared with 28% by EGD (NS). CONCLUSIONS: While commonly used as a diagnostic test for dysphagia, UGI studies have limited sensitivity for the diagnosis of EoE in adults. Characteristic features of rings and furrows are better detected on EGD than UGI. Radiologist's awareness of EoE increases the diagnostic yield of UGI detection of EoE features.