{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:04:56Z","timestamp":1790395496550,"version":"4.1.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"07","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01 DK101856"],"award-info":[{"award-number":["R01 DK101856"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["T32 DK007634"],"award-info":[{"award-number":["T32 DK007634"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University of North Carolina (UNC) Center for Gastrointestinal Biology and Disease","award":["NIH P30 DK034987"],"award-info":[{"award-number":["NIH P30 DK034987"]}]},{"name":"National Cancer Institute","award":["2-P30-CA016086-40"],"award-info":[{"award-number":["2-P30-CA016086-40"]}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"crossref","award":["2-P30ES010126-15A1"],"award-info":[{"award-number":["2-P30ES010126-15A1"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University Cancer Research Fund and North Carolina Biotechnology Center","award":["2015-IDG-1007"],"award-info":[{"award-number":["2015-IDG-1007"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:p>\n            Background\u2002Endoscopic features of eosinophilic esophagitis (EoE) are measured using the validated EoE Endoscopic Reference Score (EREFS); however, a threshold for treatment response has not been defined. We aimed to determine a cut-point for endoscopic response as measured by EREFS.<\/jats:p><jats:p>\n            Methods\u2002We performed a secondary analysis of a randomized clinical trial comparing budesonide slurry with swallowed fluticasone multidose inhaler for initial treatment of EoE. In the parent trial, EREFS was determined before and after treatment (score range 0\u20139), as were histologic findings and dysphagia symptoms. We performed tabular, flexible trend, and dependent mixture analyses of measures of treatment response to select the best clinical EREFS threshold.<\/jats:p><jats:p>\n            Results\u2002In the 111 included patients (mean age 39 years; 67\u200a% male; 96\u200a% white), an EREFS threshold of \u2264\u200a2 was 80\u200a% sensitive (95\u200a% confidence interval [CI] 69\u200a% to 88\u200a%) and 83\u200a% specific (95\u200a%CI 67\u200a% to 94\u200a%) for histologic response (peak of\u200a&lt;\u200a15 eosinophils per high-power field). Flexible trend analysis and dependent mixture modeling similarly suggested that a threshold of \u2264\u200a2 best captured the correlation of EREFS with histologic and symptomatic measures. Dependent mixture modeling found near-total membership in the response class at EREFS of 0 or 1 and &gt;\u200a75\u200a% at EREFS of 2 or 3. <\/jats:p><jats:p>\n            Conclusions\u2002An EREFS of \u2264\u200a2 was the best clinical threshold for endoscopic response to topical steroid treatment, and was consistent with clinical and histologic response. Therefore, future studies can report a binary outcome of endoscopic response when EREFS is 2 or less.<\/jats:p>","DOI":"10.1055\/a-1675-7860","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T22:51:10Z","timestamp":1634856670000},"page":"635-643","source":"Crossref","is-referenced-by-count":48,"title":["Determination of a treatment response threshold for the Eosinophilic Esophagitis Endoscopic Reference Score"],"prefix":"10.1055","volume":"54","author":[{"given":"Cary C.","family":"Cotton","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Woosley","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Department of Pathology and Laboratory Medicine, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Moist","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J.","family":"McGee","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Iuga","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Department of Pathology and Laboratory Medicine, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Shaheen","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1167-1101","authenticated-orcid":false,"given":"Evan S.","family":"Dellon","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1038\/ajg.2015.239","article-title":"A clinical prediction tool identifies cases of eosinophilic esophagitis without endoscopic biopsy: a prospective study","volume":"110","author":"E S Dellon","year":"2015","journal-title":"Am J Gastroenterol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1038\/ajg.2011.10","article-title":"Toward uniformity in the diagnosis of eosinophilic esophagitis (EoE): the effect of guidelines on variability of diagnostic criteria for EoE","volume":"106","author":"S L Sperry","year":"2011","journal-title":"Am J Gastroenterol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.cgh.2012.04.019","article-title":"The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis","volume":"10","author":"H P Kim","year":"2012","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1053\/j.gastro.2018.07.009","article-title":"Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE Conference","volume":"155","author":"E S Dellon","year":"2018","journal-title":"Gastroenterology"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1053\/j.gastro.2017.05.066","article-title":"Diagnosis and treatment of eosinophilic esophagitis","volume":"154","author":"A Straumann","year":"2018","journal-title":"Gastroenterology"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1067\/S0016-5107(03)01870-4","article-title":"Clinical and endoscopic features of eosinophilic esophagitis in adults","volume":"58","author":"J Croese","year":"2003","journal-title":"Gastrointest Endosc"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.giec.2015.08.006","article-title":"Role of endoscopy in diagnosis and management of pediatric eosinophilic esophagitis","volume":"26","author":"A B Muir","year":"2016","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.cgh.2019.01.030","article-title":"A conceptual approach to understanding treatment response in eosinophilic esophagitis","volume":"17","author":"E S Dellon","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1053\/j.gastro.2014.07.055","article-title":"Advances in clinical management of eosinophilic esophagitis","volume":"147","author":"E S Dellon","year":"2014","journal-title":"Gastroenterology"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1055\/a-1284-5891","article-title":"Clinical features and time trends associated with an endoscopically normal esophagus in active eosinophilic esophagitis","volume":"53","author":"S Eluri","year":"2021","journal-title":"Endoscopy"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1136\/gutjnl-2011-301817","article-title":"Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system","volume":"62","author":"I Hirano","year":"2013","journal-title":"Gut"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1055\/s-0034-1377781","article-title":"Evaluating the endoscopic reference score for eosinophilic esophagitis: moderate to substantial intra- and interobserver reliability","volume":"46","author":"B D van Rhijn","year":"2014","journal-title":"Endoscopy"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.cgh.2017.12.019","article-title":"Eosinophilic Esophagitis Reference Score accurately 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remission in adult patients with eosinophilic esophagitis","volume":"28","author":"B D van Rhijn","year":"2016","journal-title":"Neurogastroenterol Motil"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.cgh.2015.08.040","article-title":"Accuracy of the Eosinophilic Esophagitis Endoscopic Reference Score in diagnosis and determining response to treatment","volume":"14","author":"E S Dellon","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/apt.13845","article-title":"The Endoscopic Reference Score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis","volume":"45","author":"J Rodriguez-Sanchez","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1016\/j.cgh.2018.11.032","article-title":"Variation in endoscopic activity 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eosinophilic esophagitis (EoE)","volume":"108","author":"E S Dellon","year":"2013","journal-title":"Am J Gastroenterol"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/apt.12413","article-title":"Development and field testing of a novel patient-reported outcome measure of dysphagia in patients with eosinophilic esophagitis","volume":"38","author":"E S Dellon","year":"2013","journal-title":"Aliment Pharmacol Ther"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.17554\/j.issn.2224-3992.2015.04.562","article-title":"Evaluation of histologic cutpoints for treatment response in eosinophilic esophagitis","volume":"4","author":"W A Wolf","year":"2015","journal-title":"J Gastroenterol Hepatol Res"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.cgh.2017.09.046","article-title":"Optimal histologic cutpoints for treatment response in patients with eosinophilic esophagitis: analysis of data from a prospective cohort study","volume":"16","author":"C C Reed","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1053\/j.gastro.2014.08.028","article-title":"Development and validation of a symptom-based activity index for adults with eosinophilic esophagitis","volume":"147","author":"A M Schoepfer","year":"2014","journal-title":"Gastroenterology"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i07","article-title":"depmixS4: An R Package for Hidden Markov Models","volume":"36","author":"I Visser","year":"2010","journal-title":"J Stat Softw"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.07.011","article-title":"Optimizing the endoscopic examination in eosinophilic esophagitis","author":"E S Dellon","year":"2021","journal-title":"Clin Gastroenterol 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Straumann","year":"2020","journal-title":"Gastroenterology"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1675-7860.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T09:57:06Z","timestamp":1660125426000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1675-7860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,21]]},"references-count":36,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2022,6,28]]},"published-print":{"date-parts":[[2022,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1675-7860","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,10,21]]},"published":{"date-parts":[[2021,10,21]]}}}