Abstract
Background: Eosinophilic esophagitis (EoE) is a relatively new diagnosis, where until recently a specific international classification of disease code was missing. One way to identify patients with EoE is to use histopathology codes. We validated the clinicopathological EoE diagnosis based on histopathology reports and patient charts to establish these data sources as the basis for a nationwide EoE patient cohort.
 Methods: Through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study, we randomly selected 165 patients from five Swedish health care regions with a histopathologic diagnosis of EoE. Patients were assigned a histopathology diagnosis of EoE if they had ≥15 eosinophils per high-power field or, in the absence of eosinophil quantification, the pathologist interpreted the biopsy as consistent with EoE. Patient charts were scrutinized to see if the other diagnostic criteria were fulfilled. Of the 131 received patient charts, 111 (85%) had sufficient information to be included in the study.
 Results: Of the 111 validated patients, 99 had EoE, corresponding to a positive predictive value of 89% (95% confidence interval = 82–94%). Dysphagia was the most common symptom (n = 78, 70%), followed by food impaction (n = 64, 58%) and feeding difficulties (n = 37, 33%). Twelve patients had coexisting asthma (11%) and 16 allergic rhinitis (14%). Seventeen patients underwent esophageal dilatation (15%), of which seven had more than one dilatation. Ninety-seven (87%) patients had a proton-pump inhibitor treatment ≤2 years before or after the diagnosis. Forty-two patients (38%) had been prescribed inhalation steroids and 64 (58%) had undergone esophageal radiology.
 Conclusion: Histopathology reports from the ESPRESSO cohort with esophageal eosinophilic inflammation are suggestive of EoE.
Highlights
Eosinophilic esophagitis (EoE) has been recognized relatively recently and was first proposed as a distinct clinicopathologic entity in 1993–1994 [1, 2]
EoE is a chronic, local immune-mediated esophageal disease of the squamous esophagus. It is clinically characterized by symptoms related to esophageal dysfunction, endoscopic findings of rings, linear furrows, exudates, edema, strictures, narrowing and crepe-paper mucosa on biopsy ≥15 eosinophils per high-power field (HPF, 60 eosinophils/mm2), and eosinophilia isolated to the esophagus [4]
The diagnosis of EoE has traditionally been limited to proton-pump inhibitor (PPI) non-responders, but guidelines from an international consensus meeting in 2017 acknowledged that PPI therapy is an appropriate and effective treatment for a significant proportion of EoE patients
Summary
Eosinophilic esophagitis (EoE) has been recognized relatively recently and was first proposed as a distinct clinicopathologic entity in 1993–1994 [1, 2]. EoE is a chronic, local immune-mediated esophageal disease of the squamous esophagus. It is clinically characterized by symptoms related to esophageal dysfunction, endoscopic findings of rings, linear furrows, exudates, edema, strictures, narrowing and crepe-paper mucosa on biopsy ≥15 eosinophils per high-power field (HPF, 60 eosinophils/mm2), and eosinophilia isolated to the esophagus [4]. Eosinophilic esophagitis (EoE) is a relatively new diagnosis, where until recently a specific international classification of disease code was missing. We validated the clinicopathological EoE diagnosis based on histopathology reports and patient charts to establish these data sources as the basis for a nationwide EoE patient cohort. Conclusion: Histopathology reports from the ESPRESSO cohort with esophageal eosinophilic inflammation are suggestive of EoE
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