ASGE Recognized Industry Associate (ARIA) Training Program for Regeneron | June 2022-Pathologist's Perspective of EoE

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The document discusses the perspective of pathologists on eosinophilic esophagitis (EoE). It outlines the differential diagnoses of intraepithelial eosinophilia and characterizes the histologic criteria of EoE. The document also discusses the clinical findings that help in distinguishing and reaching a diagnosis of EoE.<br /><br />EoE is a chronic immune-mediated esophageal disease characterized by symptoms related to esophageal dysfunction and histologically by eosinophil predominant inflammation. It is more prevalent in males and is associated with atopic conditions such as food allergy, asthma, eczema, and allergic rhinitis.<br /><br />Pathologists make the diagnosis of EoE based on various criteria. Histologically, the presence of at least 15 eosinophils per high power field (or 60 eosinophils/mm2) isolated to the esophagus is indicative of EoE. However, there are limitations to this method, including limited correlation with symptoms and tissue sampling variability.<br /><br />EoE can be distinguished from reflux esophagitis based on certain features. EoE is associated with diffuse involvement of the epithelium, degranulated eosinophils, eosinophil micro abscesses, and marked lamina propria fibrosis. Reflux esophagitis, on the other hand, is characterized by basal cell hyperplasia involving only 20-50% of the epithelium.<br /><br />To make an accurate diagnosis, pathologists rely on a combination of clinical findings, endoscopic findings, and histopathological features. Endoscopic findings such as furrowing, rings, edema, and exudates can help differentiate EoE from reflux esophagitis. Additionally, endoscopic ultrasound can be used to evaluate the involvement of the esophageal layers.<br /><br />In conclusion, pathologists play a crucial role in diagnosing EoE by evaluating histopathological features and correlating them with clinical and endoscopic findings. A combination of all these factors is necessary to reach an accurate diagnosis of EoE.

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Adam Booth, MD

Keywords

pathologists

eosinophilic esophagitis

EoE

differential diagnoses

intraepithelial eosinophilia

histologic criteria

clinical findings

diagnosis

reflux esophagitis

endoscopic findings