Prospective Endoscopic Activity Assessment for Eosinophilic Gastritis in a Multisite Cohort

Ikuo Hirano; Margaret H Collins; Eileen King; Qin Sun; Mirna Chehade; J Pablo Abonia; Peter A Bonis; Kelly E Capocelli; Evan S Dellon; Gary W Falk; Nirmala Gonsalves; Sandeep K Gupta; John Leung; David Katzka; Paul Menard-Katcher; Paneez Khoury; Amy Klion; Vincent A Mukkada; Kathryn Peterson; Tetsuo Shoda; Amanda K Rudman-Spergel; Jonathan A Spergel; Guang-Yu Yang; Marc E Rothenberg; Seema S Aceves; Glenn T Furuta; CEGIR investigators

doi:10.14309/ajg.0000000000001625

Prospective Endoscopic Activity Assessment for Eosinophilic Gastritis in a Multisite Cohort

Am J Gastroenterol. 2022 Mar 1;117(3):413-423. doi: 10.14309/ajg.0000000000001625.

Authors

Ikuo Hirano¹, Margaret H Collins², Eileen King³, Qin Sun³, Mirna Chehade⁴, J Pablo Abonia^{3

5}, Peter A Bonis⁶, Kelly E Capocelli⁷, Evan S Dellon⁸, Gary W Falk⁹, Nirmala Gonsalves¹, Sandeep K Gupta¹⁰, John Leung⁶, David Katzka¹¹, Paul Menard-Katcher¹², Paneez Khoury¹³, Amy Klion¹⁴, Vincent A Mukkada¹⁵, Kathryn Peterson¹⁵, Tetsuo Shoda⁵, Amanda K Rudman-Spergel¹⁶, Jonathan A Spergel¹⁷, Guang-Yu Yang^{1

18}, Marc E Rothenberg^{3

5}, Seema S Aceves¹⁹, Glenn T Furuta⁷; CEGIR investigators

Affiliations

¹ Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
² Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
³ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁴ Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵ Division of Allergy and Immunology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁶ Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA.
⁷ Digestive Health Institute, Children's Hospital of Colorado, Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO, USA.
⁸ University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
⁹ Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁰ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children/Indiana University School of Medicine, and Community Health Network, Indianapolis, IN, USA.
¹¹ Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
¹² Division of Gastroenterology, University of Colorado, Denver, Colorado, USA.
¹³ Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland, USA.
¹⁴ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁵ Department of Gastroenterology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
¹⁶ Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA.
¹⁷ Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA, USA.
¹⁸ Division of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁹ Department of Pediatrics and Medicine, University of California San Diego, San Diego, California, USA.

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Endoscopy, Gastrointestinal
Enteritis* / diagnosis
Enteritis* / pathology
Eosinophilia* / diagnosis
Eosinophilia* / pathology
Eosinophilic Esophagitis* / pathology
Gastritis* / diagnosis
Gastritis* / pathology
Humans

Supplementary concepts

Eosinophilic enteropathy

Abstract

Publication types

MeSH terms

Supplementary concepts

Grants and funding