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Updated: Apr 18, 2026
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Value of an Additional Review for Eosinophil Quantification in Esophageal Biopsies
Emily M Stucke1, Katherine E Clarridge, Margaret H Collins
1*Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center †Department of Pediatrics, University of Cincinnati College of Medicine ‡Division of Pathology and Laboratory Medicine §Division of Human Genetics ||Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Abstract:
Eosinophilic esophagitis (EoE) requires a peak count of 15 eosinophils per high-power field (hpf). Herein, the peak eosinophil count specified by a pathologist was compared with the second review of a research assistant. Of 477 biopsies, 106 had a peak count between 1 and 14 eosinophils/hpf cited in the pathology report, and 23/106 (22%) had ≥15 eosinophils/hpf on second review. The pathology report detected potential EoE with 99% specificity, but 80% sensitivity. As such, an additional review of esophageal biopsies yields higher eosinophil counts in ∼5% of cases. We propose that biopsies with a count between 1 and 14 eosinophils/hpf require further investigation because ∼22% may yield a potential EoE diagnosis.
