Food allergy and PPI-responsive esophageal eosinophilia
Bibliographic record
Abstract
Eosinophilic esophagitis (EoE) is considered a chronic condition mediated by immune reaction to food and/or environmental allergens. Though first recognized decades ago, the characterization of EoE is ongoing and an important aspect of this process is the distinction between EoE and other forms of esophageal eosinophilia [ 1 , 2 ]. One group of patients exhibit marked esophageal eosinophilia (>15 eo/HPF), negative esophageal pH-monitoring studies and yet have clinicopathologic response to proton-pump inhibitor (PPI) treatment: this group is categorized as having PPI-responsive esophageal eosinophilia (PPI-REE) [ 1 , 3 ]. It is not certain whether those with PPI-REE are cases of GERD undiagnosed by pH-monitoring, EoE responding to PPI therapy as in-vitro studies suggest [ 4 ], or some combination thereof. GERD is orders of magnitudes more prevalent than EoE and thus misdiagnosed cases of GERD could have significant impact on any study of EoE patients [ 5 , 6 ]. Other groups have attempted to distinguish cases of PPI-REE and EoE, but failed to do so using clinicopathologic criteria [ 7 , 8 ]. This retrospective review of patients diagnosed with EoE aimed to differentiate PPI-REE and non-responsive patients, with an emphasis on prevalence of food allergy between the two groups. A chart review was performed for 30 patients diagnosed with EoE, prescribed PPI therapy and tested with atopic patch tests for a panel of food allergens. Patients were categorized as having PPI-REE if past clinical assessments noted significant symptomatic improvement with PPI therapy. Of the 30 patients reviewed, 12 were found to have PPI-REE. There was no significant difference in other treatments offered to PPI-REE and non-responsive patients, the eosinophil counts at diagnosis, nor in likelihood of food allergy as detected by skin prick or food patch testing (Table 1 ). It was hypothesized that PPI-REE cases would be less atopic, with regards to foods, than non-responders due to the possible prevalence of undiagnosed GERD in the former group. However, this review failed to show any statistically significant differences between the two groups. This is consistent with attempts of other groups to distinguish PPI-REE and EoE patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".