Do endoscopic features suggesting eosinophilic esophagitis represent histological eosinophilia?

Area of Science:

• Gastroenterology
• Endoscopy
• Histopathology

Background:

• Eosinophilic esophagitis (EoE) diagnosis relies on identifying esophageal eosinophilia.
• Common endoscopic findings include linear furrows, corrugated rings, and white exudates, but their specificity for EoE is uncertain.

Purpose of the Study:

• To evaluate the diagnostic utility of specific endoscopic features for identifying esophageal eosinophilia.
• To determine if linear furrows, corrugated rings, and white exudates are specific indicators of eosinophilic esophagitis.

Main Methods:

• A consecutive cohort of 2763 patients underwent endoscopic surveillance.
• Target biopsies were performed for patients exhibiting linear furrows, corrugated rings, or white exudates.
• Histological analysis defined eosinophilia as ≥24 eosinophils per high-power field (HPF).

Main Results:

• Among biopsied patients with these features, eosinophilia was confirmed in 14% (linear furrows), 23% (corrugated rings), and 5% (white exudates).
• Eosinophil counts were significantly higher in linear furrows (12 HPF) and corrugated rings (9 HPF) compared to white exudates (<1 HPF).
• Only 2 out of 5 patients with confirmed eosinophilia were diagnosed with EoE.

Conclusions:

• Endoscopic findings suggestive of EoE are not always specific for esophageal eosinophilia.
• Linear furrows and corrugated rings have superior diagnostic utility for esophageal eosinophilia compared to white exudates.
• While these endoscopic features can prompt consideration of EoE, they require histological confirmation.