Eosinophilic esophagitis: a paradigm shift for pathology

Area of Science:

• Gastroenterology
• Pathology
• Histology

Background:

• Eosinophilic esophagitis (EoE) is increasingly recognized, with adult literature reporting it since 1993.
• This study evaluates steroid-naive EoE patients from 1988, describing the evolution of its histologic diagnosis.
• The facility's early patient data allows for a unique historical perspective on EoE diagnosis.

Purpose of the Study:

• To describe the evolution of the histologic diagnosis of Eosinophilic Esophagitis (EoE).
• To analyze the impact of diagnostic guidelines on EoE recognition.
• To re-evaluate historical biopsy specimens based on current EoE criteria.

Main Methods:

• Retrospective analysis of 95 patient charts (1988-2012) with initial diagnoses including EoE.
• Review of histologic slides from 10 patients against current EoE diagnostic criteria (≥15 eosinophils/HPF).
• Comparison of original interpretations with re-evaluated diagnoses for biopsy specimens.

Main Results:

• Pathologists began recognizing EoE as distinct in 2007, coinciding with the first EoE guidelines.
• A significant increase in EoE histologic diagnoses was observed after 2007.
• Re-evaluation of slides initially diagnosed as reflux esophagitis (RE) or inflammation revealed EoE in 79% of cases.

Conclusions:

• Eosinophilic esophagitis (EoE) has been present for at least 2-3 decades.
• The study marks a clear paradigm shift in the histologic diagnosis of EoE as a distinct entity.
• A seminal consensus report significantly influenced the recognition and diagnosis of EoE.