Increased prevalence of esophageal squamous cell papilloma in eosinophilic esophagitis: incidental finding or disease...

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease with increasing prevalence. Squamous papilloma of the esophagus is a rare benign lesion, with prevalence estimates of 0.014%-0.45% and association in EoE has not been reported. Our aims were to determine the prevalence of papilloma in a large cohort of EoE adults and clinical features of EoE associated with papilloma. We performed a retrospective chart review of EoE adults at two academic centers from 2002 to 2013 using current EoE consensus guidelines. Extracted data included patient demographics, clinical features, endoscopic findings, and histological information. Papilloma findings were confirmed by review by a senior gastrointestinal pathologist. A subset of papilloma biopsies was stained for human papilloma virus (HPV) and cell proliferation via ki-67 staining. In a cohort of 454 EoE patients, 41 patients (9%) presented with a papilloma. 46% were male, median age of 42 years (ranging 18-82). The median size of papilloma was 3 mm (range 1-5 mm); 63% were in the mid/proximal esophagus. Features of age, disease duration, eosinophil count, and atopy did not differentiate EoE patients with/without papilloma. Patients with papilloma were more likely to be female, have endoscopic exudates and edema. Papillomas stained negative for HPV and normal ki-67 staining. (1) The prevalence of papilloma in EoE adults was 9%, which represents a 24-fold increase than estimates in the general population. (2) Female gender and inflammatory endoscopic features were more common in EoE patients with papillomas. (3) The clinical significance of papilloma in EoE is unknown and merits further investigation.