S376 Patients With Eosinophilic Esophagitis and Gastrointestinal Symptoms May Have Eosinophilic Gastritis and/or Duodenitis, Not Associated With Peak Esophageal Eosinophil Count

Abstract

Introduction: Many patients with eosinophilic esophagitis (EoE) present with extra-esophageal or atypical symptoms. We previously evaluated gastric and duodenal biopsies from patients with EoE with and without persistent extra-esophageal gastrointestinal (GI) symptoms to determine if they had eosinophilic gastritis and/or duodenitis (EG and/or EoD)1. In this study, we investigated correlations between peak esophageal eosinophil counts and concomitant EG and/or EoD. Methods: We studied 45 patients with EoE and GI symptoms (abdominal pain, nausea, bloating) and/or a previous diagnosis of irritable bowel syndrome (EoE+S) and 12 patients with EoE without extra-esophageal symptoms (EoE–S). All had initial gastric and duodenal biopsies interpreted as non-specific inflammation or normal. Gastric and duodenal eosinophils were systematically counted in biopsies by a blinded GI pathologist; EG and EoD were defined as ≥30 eosinophils/high-power field (hpf) in ≥5 hpfs in gastric and ≥3 hpfs in duodenal specimens, respectively. Results: Thirty-one of the 45 EoE+S patients (69%) met histologic criteria for EG and/or EoD: 8 (18%) met histologic criteria for EG and 23 (51%) met histologic criteria for EoD. None of the EoE–S patients met histologic criteria for EG and 3 met histologic criteria for EoD. Peak esophageal eosinophil counts did not differ significantly between patients with EoE+S vs EoE–S, and were not associated with the presence of EG or EoD (Figure 1). Conclusion: Sixty-9 percent of patients with EoE and extra-esophageal GI symptoms met the histologic criteria for EG and/or EoD. Peak esophageal eosinophil counts were not associated with the presence of EG or EoD and therefore should not be used to guide gastroduodenal biopsy. Patients with EoE and persistent extra-esophageal GI symptoms, regardless of peak esophageal eosinophil counts, should undergo systematic collection and histologic analysis of gastric and duodenal biopsies to identify those with concomitant EG and/or EoD.Figure 1.: Peak Esophageal Eosinophil Counts in Patients With EoE, With vs Without GI Symptoms EoE+S EG: patients with EoE and extra-esophageal GI symptoms who met criteria for EG (≥30 eos in ≥5 gastric hpfs) EoE+S EoD: patients with EoE and extra-esophageal GI symptoms who met criteria for EoD (≥30 eos in ≥3 duodenal hpf) EoE–S: patients with EoE without extra-esophageal GI symptoms Dotted line indicates histologic threshold for EG and/or EoD Caps indicate minimum and maximum; box, 25th and 75th percentile; center line, median P value from unpaired t test of simple 1-way ANOVA, compared with EoE-S Note: Some patients were receiving treatment for EoE at the time of esophageal biopsy collection.