Endoscopic Classification of Eosinophilic Esofagitis

Abstract

Introduction: The purpose of this study is to suggest an endoscopic classification of eosinophilic esophagitis (EE) to better recognize this disease and guide biopsies for histological diagnosis. Methods: This study consisted in a prospective research (September 2011 to September 2013) with biopsies performed in all patients who had endoscopic findings or symptoms that suggested EE, supporting an classification as follow: Type 0 = Normal endoscopy with typical symptoms; Type 1 = Linear furrows or rings, with or without symptoms; Type 2 = White plaques and exudates, with or without symptoms; and Type 3 = Complicated lesions like ulcer, strictures and polyps. Results: Following this classification, 133 patients were included. Twenty-four presented at least 15 eosinophils per high-power microscopic field (HPMF), that was considered Group A (GA). Also, 10 cases with 5-14 eosinophils/HPMF with typical symptoms and/or endoscopic findings were detected, that was considered Group B (GB). Linking the groups A and B with the endoscopic classifications was found: Type 0, Type 1, Type 2, Type 3, Group A 2 9 8 5, Group B 0 6 2 2. For comparison, a retrospective research on medical archives in the same endoscopic clinic was done during previous two years: only two patients with at least 15 eosinophils/HPMF were diagnosed. Conclusion: The findings showed that an investigation based on a pre-established protocol and classification can increase a lot the diagnosis of this disease. The question is if cases with clinical and/or endoscopic findings suggesting EE and with minor than 15 eosinophils/ HPMF could be included in the diagnosis of EE.Table 1