Abstract
Background
EoE is an increasingly recognized cause of upper gastrointestinal symptomatology particularly dysphagia. The gold standard for diagnosis is the presence of increased eosinophils on esophageal biopsies. To distinguish EoE from esophageal eosinophilia due to gastroesophageal reflux disease (GERD), many physicians routinely separate biopsies from the mid and distal esophagus, theorizing that eosinophils will be more numerous in the distal esophagus in GERD and more diffusely distributed in EoE. The aim of our study was to determine if this approach was truly helpful in clinical practice.
Aims
To determine the utility of comparing distal and mid-esophageal counts in differentiating EoE from GERD.
Methods
All endoscopically obtained biopsies of the esophagus taken at London Health Sciences Centre between July 1, 2011 and June 30, 2014 were eligible for review. Patients were only included if they were 18 year old or older and biopsies were taken from the mid and distal esophagus for non-neoplastic findings and separated for review. The pathology was then reviewed by a pathologist blinded to diagnosis and a mean eosinophil count per high-power field (hpf) was calculated for each area. A delta eosinophil count (DEC) was calculated by subtracting the mean count in the distal esophagus from the mean count in the mid-esophagus. If multiple endoscopies were performed, only the first biopsy after the study initiation date was used.
Results
603 patients were included in the analysis. Of these 138 (22.9 %) had a final diagnosis of GERD, 124 (20.6 %) EoE and 341 (56.5 %) normal. The most common predominant symptoms in GERD were heartburn 99 (71.7 %) and dysphagia to solids 70 (50.7 %). The most common predominant symptoms in EoE were dysphagia to solids 90 (72.6 %), atopic symptoms 41 (33.1 %), heartburn 40 (32.3 %) and food impaction 38 (30.6 %). The most common endoscopic findings in EoE were furrows 81 (65.3 %), trachealization 70 (56.4 %) and stricture 29 (32.4 %). The mean eosinophil count in the distal and mid-esophagus respectively was 6.6 and 2.8 in GERD, 80.4 and 76.9 in EoE and 0 and 0 in normal patients. The DEC was positive in 20.3 % of GERD patients and 41.1 % of EoE patients. The mean DEC was -3.8 in GERD patients and -3.5 in patients with EoE.
Conclusions
Mucosal eosinophilia is significantly more pronounced in patients with EoE although the difference between eosinophil counts in the mid and distal appears to be of only marginal value in distinguishing between the two diagnoses. Separating specimens for analysis does not appear to be necessary.
Funding Agencies
None