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Diagnosing oesophagitis in children: how discriminative is histology?
Y Y Karabulut1, B Savaş, A Kansu
1Department of Pathology, Ankara University, Medical School. yykarabulut@yahoo.com.tr
Insights
Histologic markers like basal cell hyperplasia, papillary elongation, and dilated intercellular spaces are nonspecific for differentiating pediatric reflux esophagitis from eosinophilic esophagitis. Inflammatory cell counts, however, aid in diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Distinguishing pediatric reflux esophagitis (RE) from eosinophilic esophagitis (EoE) is clinically important.
- Histologic criteria are used for diagnosis, but their discriminatory value requires evaluation.
Purpose of the Study:
- To assess the diagnostic accuracy of current histologic criteria in differentiating pediatric RE from EoE.
- To identify reliable histologic markers for differential diagnosis.
Main Methods:
- Esophageal biopsies from 145 children were reviewed.
- 28 cases (7 EoE, 11 RE, 10 controls) were selected for detailed analysis.
- Histologic features assessed included papillary elongation, intercellular spaces, basal cell hyperplasia, and inflammatory cell counts (eosinophils, lymphocytes, neutrophils).
Main Results:
- Basal cell hyperplasia, papillary elongation, and dilated intercellular spaces were observed in both RE and EoE, indicating their nonspecific nature.
- Lymphocyte and neutrophil counts were significantly higher in the RE group compared to EoE and controls.
- Eosinophil counts were significantly elevated in the EoE group.
Conclusions:
- Papillary elongation, basal cell hyperplasia, and dilated intercellular spaces are nonspecific markers for esophagitis in children.
- Inflammatory cell counts, particularly eosinophils, are crucial for differentiating EoE from RE.
- Histologic assessment combined with inflammatory cell differentials aids in diagnosing pediatric esophagitis.
Background And Study Aims:
We set out to evaluate the discriminatory value of currently available histologic criteria in the differential diagnosis of reflux oesophagitis and eosinophilic oesophagitis in children.
Patients And Methods:
We evaluated the oesophageal biopsies of 145 children and selected 28 demonstrative cases of clinically confirmed eosinophilic oesophagitis (n = 7), and reflux oesophagitis (n = 11) with a control group with normal histology (n = 10). Histological assessment was performed for the presence of papillary elongation, dilatation of intercellular spaces, basal cell hyperplasia and the number of intraepithelial eosinophils, lymphocytes and neutrophils.
Results:
Among 28 children, there were 3 boys and 4 girls in eosinophilic oesophagitis group, 8 boys and 3 girls in reflux group, and 5 boys and 5 girls in normal group. The mean age was 10,4 years. Basal cell hyperplasia was observed in 12 cases while papillary elongation was found in 25, and dilated intercellular spaces were present in 20 cases. Lymphocyte and neutrophil counts were significantly higher in reflux group when compared to eosinophilic oesophagitis and normal group. Eosinophil counts were significantly higher in eosinophilic group.
Conclusions:
Results of the present study suggest that, basal cell hyperplasia, papillary elongation, and dilated intercellular spaces all seem to be markers of oesophagitis regardless of the underlying pathology and etiology, thereby, highlighting their rather nonspecific nature in the differential diagnosis of various types of oesophagitis. The additional information on inflammatory cell counts may help to distinguish reflux oesophagitis from other causes of oesophagitis including EoO.
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