EoE ToT Module 5 References-Gonsalves et al Gastrointest Endosc 2006 Histopathologic variability and endoscopic correlates in adults with EoE

Gonsalves et al Gastrointest Endosc 2006 Histopathologic variability and endoscopic correlates in adults with EoE

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The study investigates the variability in histopathologic features of eosinophilic esophagitis (EE) in adults. EE is increasingly recognized as a significant cause of dysphagia and food impaction due to eosinophil infiltration in the esophageal mucosa. The research aimed to determine the optimal number and location of biopsies required for its diagnosis.<br /><br />Charts of 74 patients diagnosed with EE were reviewed. A total of 341 biopsy specimens from 66 patients revealed significant variability in eosinophil counts both within and between individual specimens. The median eosinophil count per high-power field (eos/hpf) was 107. Sensitivity for diagnosing EE increased with the number of biopsy specimens: one biopsy specimen had a sensitivity of 55%, which rose to 100% after obtaining five biopsies. <br /><br />The study also compared eosinophil levels from proximal and distal esophageal sites, finding no significant difference. Additionally, samples from EE patients showed substantially higher eosinophil counts compared to those from patients with Schatzki’s ring, which had a negligible eosinophil presence.<br /><br />The findings underscore significant histologic variability in EE, advocating for multiple biopsies from both proximal and distal locations to ensure accurate diagnosis. The study also highlighted a greater need for biopsy specimens when using stricter eosinophil thresholds to achieve higher sensitivity.<br /><br />Common endoscopic features of EE identified include concentric mucosal rings and linear furrows. Despite some patients showing characteristic endoscopic signs, 15 patients did not meet the histologic criteria for EE, suggesting the possibility of sampling error, histologic variability over time, or eosinophils being present in deeper layers of the esophagus.<br /><br />In conclusion, the study recommends taking multiple biopsy specimens from various esophageal locations to improve diagnostic accuracy and sensitivity in EE diagnosis, emphasizing the need for comprehensive biopsy protocols for better recognition and early treatment of EE.

Keywords

eosinophilic esophagitis

histopathologic variability

dysphagia

food impaction

biopsy specimens

eosinophil counts

diagnostic sensitivity

proximal and distal esophagus

concentric mucosal rings

linear furrows