Eosinophilic Esophagitis – Recognition, Diet and Drugs
Bibliographic record
Abstract
E osinophilic esophagitis (EoE) is an immune-mediated disorder trig- gered by food or other environmental antigens.EoE presents with food impaction and dysphagia in adults.In children, the symptoms may be more diverse including failure to thrive, vomiting, gagging and gastroesophageal reflux-like symptoms.Overall, the prevalence of EoE in the general population is approximately 50 per 100,000.EoE is mediated by T helper cell 2 cytokines such as interleukin (IL)-4, IL-5 and IL-13, which promote eosinophil recruitment via eotaxin-3 (1).The diagnosis of EoE depends on the presence of esophageal dysfunction symptoms, the exclusion of gastroesophageal reflux and the presence of 15 or more eosinophils per high-power microscopy field in esophageal biopsy, with the eosinophilia limited to the esophagus.Proton pump inhibitor-responsive EoE is also a recognized subgroup.Although EoE may present with normal endoscopic findings, characteristic endoscopic features are increasingly being recognized.These include esophageal rings, strictures, narrow-calibre esophagus, linear furrows, white plaques or exudates, and pallor or decreased vasculature.These findings help to diagnose EoE by guiding biopsy decisions and to assess a patient's response to therapy (2).In a systematic review of endoscopic findings from patients with EoE, Kim et al (3) recently demonstrated a high pooled prevalence of at least one endoscopic finding in patients with EoE, although prevalence rates for individual findings varied and could be low.They concluded that individual endoscopic findings had high levels of specificity but low sensitivity, and the predictive values were inadequate for diagnostic purposes.Using high-resolution endoscopy with filter techniques or using confocal endomicroscopy may increase diagnostic yields, but endoscopist education and familiarity with the abnormalities may be crucial in not missing subtle abnormalities (Figure 1).The medical treatment of EoE is predominantly via use of topical steroids, either swallowed fluticasone or oral viscous budesonide; the latter may be more effective (4).Second-line medical therapies include systemic steroids and the leukotriene antagonist montelukast.Proton pump inhibitors may be useful because some patients are responsive.Esophageal strictures may be dilated at endoscopy followed by medical therapy (1).Such dilation may be as safe as dilating other benign strictures.
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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 | 0.003 | 0.008 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.010 | 0.012 |
| Insufficient payload (model declined to judge) | 0.007 | 0.004 |
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".