High intraepithelial eosinophil counts in esophageal squamous epithelium are not specific for eosinophilic esophagitis in adults
High intraepithelial eosinophil counts in esophageal squamous epithelium are not specific for eosinophilic esophagitis in adults
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DOI：
10.1111/j.1572-0241.2007.01594.x
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发表时间：
2008-02-01
影响因子：
9.8
通讯作者：
Chandrasoma, Parakrama
中科院分区：
文献类型：
--
作者：
Rodrigo, Sonall;Abboud, Gebran;Chandrasoma, Parakrama
目的：目前认为，每高倍视场（hpf）嗜酸性粒细胞bbbb20的组织学标准可以确定特发性嗜酸性粒细胞性食管炎（IEE）的诊断。这是基于胃食管反流病（GERD）上皮内嗜酸性粒细胞数量小于20/hpf的数据。这项研究验证了这一观点。方法：对食管活检中嗜酸性粒细胞计数为bbb20 /hpf的患者进行病理记录检索。该患者群体偏向于对食管进行常规多水平活检的成人胃食管反流。研究了临床、放射学、测压资料和活组织检查。结果：在总共3,648例报告中，有40例患者在食管活检的鳞状上皮中有嗜酸性粒细胞计数bbb20 /hpf。40例患者中，IEE 6例（15%），IEE合并GERD 2例（5%），GERD 28例（70%），贲门失弛缓合并憩室各2例（5%）。在最大嗜酸性粒细胞数量、嗜酸性粒细胞/hpf的活检水平、嗜酸性微脓肿的存在、嗜酸性粒细胞浸润表层、基底细胞增生和细胞间隙扩张的严重程度等方面，这些组之间没有显著差异。结论：目前归因于IEE的所有组织学特征均可出现在其他食管疾病中，尤其是胃食管反流。因此，任何数量的上皮内嗜酸性粒细胞增多的发现都不是IEE所特有的。当胃食管反流患者食道活检显示嗜酸性粒细胞计数为bbb20 /hpf时，并不意味着患者患有IEE。
OBJECTIVES: The histologic criterion of >20 eosinophils per high power field (hpf) is presently believed to establish the diagnosis of idiopathic eosinophilic esophagitis (IEE). This is based on data that the number of intraepithelial eosinophils in gastroesophageal reflux disease (GERD) is less than 20/hpf. This study tests this belief.METHODS: Pathology records were searched for patients who had an eosinophil count >20/hpf in an esophageal biopsy. This patient population was biased toward adults with GERD who had routine multilevel biopsies of the esophagus. The clinical, radiological, and manometric data and biopsies were studied.RESULTS: Forty patients out of a total of 3,648 reports examined had an eosinophil count >20/hpf in squamous epithelium of an esophageal biopsy. Analysis of these 40 cases indicated that 6 (15%) patients had IEE, 2 (5%) had coincident IEE and GERD, 28 (70%) had GERD, and 2 (5%) each had achalasia and diverticulum. There was no significant difference among these groups in terms of maximum eosinophil number, biopsy levels with >20 esoinophils/hpf, presence of eosinophilic microabscesses, involvement of surface layers by eosinophils, and severity of basal cell hyperplasia and dilated intercellular spaces.CONCLUSION: All histologic features presently ascribed to IEE can occur in other esophageal diseases, notably GERD. As such, the finding of intraepithelial eosinophilia in any number is not specific for IEE. When a patient with GERD has an esophageal biopsy with an eosinophil count >20/hpf, it does not mean that the patient has IEE.