Reliability of Histopathology in Diagnosing Eosinophilic Esophagitis in Adults

Abstract

Purpose: Eosinophilic esophagitis (EE) is an increasingly recognized cause of dysphagia in adults. There are no diagnostic serum markers, and the diagnosis is based upon the presence of characteristic clinical features and histology. Multiple biopsies of the esophagus are necessary to improve diagnostic sensitivity and reliably diagnose EE (Gonsalves et al., GIE 2006). To assess the diagnostic accuracy and reliability of proximal and mid-esophageal biopsies in EE patients. Methods: Data from 16 patients with EE was evaluated. All 16 patients completed an EGD with proximal and mid-esophageal biopsies. Results: A total of 130 biopsy specimens from 16 patients were available for analysis. Thirteen of the 16 patients were male. All patients had solid dysphagia and 5 had a history of food bolus while on proton pump inhibitor therapy. Applying the criteria of ≥15 eos/hpf for diagnosis, 54% (70 of 130) of the total biopsies, 47% (27 of 57) of the proximal biopsies and 59% (43 of 73) of the mid biopsies were found to be positive and diagnostic for EE. Of the 16 patients, 2 had positive biopsies in the proximal esophagus only, 4 in the mid esophagus only, and 10 in both locations. Further analysis revealed neither the location nor number of biopsies to be a good predictor of EE (P=NS). Conclusion: Novel histopathologic and endoscopic imaging tools may allow for fewer biopsies to accurately and reliably diagnose EE.