Intraepithelial eosinophils in endoscopic biopsies of adults with reflux esophagitis

A consecutive series of 50 adult patients was reviewed to evaluate the utility of endoscopic grasp biopsies of the esophagus in the diagnosis of reflux esophagitis. Endoscopic and histologic features were independently recorded and correlated. Measurements of basal zone thickness, papillary height, and vascular dilatation were possible in only 14% of the cases because of limited specimen orientation. However, 62% of the patients had other histologic features of esophagitis, including intraepithelial eosinophils, intraepithelial neutrophils, and epithelial necrosis. Intraepithelial eosinophils were the most frequent abnormality; they were noted in 52% of the cases and correlated best with the gross endoscopic features. Eosinophils were easily identified even in the poorly oriented grasp biopsies and were the only histologic finding in seven patients (23% of the abnormal cases). Thus, we conclude that esophageal grasp biopsies taken at the time of endoscopy are of value in the assessment of patients with suspected reflux esophagitis, and intraepithelial eosinophils are the most common and useful histologic criterion. This feature was previously observed in children and occurs as well in adults with reflux esophagitis.