Original ArticleHistopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis
Section snippets
Patients and methods
We reviewed the charts of 74 adult patients with a known diagnosis of EE, based on an eosinophil count exceeding 15 eos/hpf, seen at our hospital from January 1999 to July 2004. Patients with concomitant eosinophilic infiltration in the stomach or the duodenum were excluded. Data, including sex, age, nature and duration of symptoms, medical history, allergies, medications, peripheral eosinophilia, and family history, were recorded. Endoscopic findings were also recorded. Results from a barium
Demographics
During the study period, 89 patients were encountered with a suspected diagnosis of EE based on endoscopic findings. Of these, 74 had a diagnosis of EE confirmed by histology and were included. Despite characteristic endoscopic features of EE, 15 patients were excluded because their biopsy specimens did not demonstrate significant eosinophilia. The median number of biopsy specimens taken in the excluded group was 4 (range, 2-8). Every hpf of each biopsy specimen was reviewed to assure that the
Discussion
Our study included 74 adult patients with EE, making it the largest adult series and the first prospective histopathologic analysis reported. Because the diagnosis of EE is based on histopathology, we examined the optimal number and location of biopsy specimens necessary for diagnosis. Significant variability exists in eosinophil concentrations among biopsy specimens, such that limited biopsy sampling may lead to false-negative results. Based on our data, by using a diagnostic threshold of ≥15
Acknowledgments
The authors wish to thank Peter J. Kahrilas, MD, for his critical review of this manuscript and support of this study. The authors would also like to thank the Gastroenterology faculty and fellows at Northwestern University for their recruitment of patients.
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