Histopathologic variability in children with eosinophilic esophagitis.

Area of Science:

• Gastroenterology
• Pediatric Pathology
• Allergy & Immunology

Background:

• Eosinophilic esophagitis (EoE) diagnosis relies on esophageal squamous epithelium eosinophilia.
• Variability in eosinophil infiltration complicates accurate diagnosis.
• Determining the optimal number of biopsies is crucial for diagnostic accuracy in pediatric EoE.

Purpose of the Study:

• To evaluate histopathologic features in pediatric EoE patients.
• To determine the optimal number of esophageal biopsies for EoE diagnosis.

Main Methods:

• Reviewed 221 biopsy specimens from 30 pediatric EoE patients (median 7.8 biopsies/patient).
• All patients had >15 eosinophils per high-power field (eos/HPF) and underwent 24-h pH monitoring.
• Biopsies analyzed from mid and distal esophagus.

Main Results:

• Single biopsy sensitivity was 73%; three biopsies increased sensitivity to 97%.
• Using >15 eos/HPF, three biopsies diagnosed 97% of EoE cases.
• Biopsy site matters: 17% missed with mid-esophagus only, 3% missed with distal only.

Conclusions:

• Significant histologic variability necessitates multiple biopsies for EoE diagnosis.
• Three biopsies achieve 97% diagnostic sensitivity for pediatric EoE (>15 eos/HPF).
• EoE histopathology can persist despite PPI therapy in patients with GERD.