EoE Module 14 References-Dellon et al Mod Pathol 2015 Distribution and variability of esophageal eosinophilia in patients undergoing upper endoscopy

Dellon et al Mod Pathol 2015 Distribution and variability of esophageal eosinophilia in patients undergoing upper endoscopy

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The study, conducted by researchers from the University of North Carolina, focused on understanding the variability and distribution of esophageal eosinophilia in patients undergoing upper endoscopy. This prospective study included 213 adults presenting for outpatient endoscopy. The aim was to assess the eosinophil counts in esophageal biopsies and determine the efficacy of existing diagnostic thresholds for eosinophilic esophagitis. Researchers obtained biopsies from multiple esophageal regions, yielding 923 biopsy fragments and 4588 high-power fields (hpfs) for analysis.<br /><br />The findings revealed that a majority of patients had low levels of esophageal eosinophilia, with 23% of patients, 18% of biopsy fragments, and 10% of hpfs exhibiting more than 15 eosinophils per high-power field (eos/hpf). However, among those diagnosed with eosinophilic esophagitis, a significant concentration and variability of eosinophil counts were noted. Most biopsies in eosinophilic esophagitis cases had at least one hpf with 15 or more eosinophils, showing a marked variability that necessitates multiple biopsies for accurate diagnosis. <br /><br />The study confirmed the diagnostic cut-point of 15 eos/hpf exhibited a sensitivity of 100% and specificity of 96% for identifying eosinophilic esophagitis, making it a reliable threshold. Other potential causes of esophageal eosinophilia such as gastroesophageal reflux disease and proton pump inhibitor-responsive esophageal eosinophilia were also considered. <br /><br />The research underscores the importance of obtaining several biopsy samples from various esophageal locations to ensure an accurate diagnosis, due to the patchy nature of the eosinophilic infiltrate. Overall, this study supports the current diagnostic guidelines and provides a foundation for refining biopsy protocols and clinical trial designs for eosinophilic esophagitis.

Keywords

esophageal eosinophilia

eosinophilic esophagitis

upper endoscopy

eosinophil counts

diagnostic thresholds

biopsy fragments

high-power fields

University of North Carolina

gastroesophageal reflux disease

proton pump inhibitor