Histopathologic Variability in Children With Eosinophilic Esophagitis
Histopathologic Variability in Children With Eosinophilic Esophagitis
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DOI：
10.1038/ajg.2008.117
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发表时间：
2009-03-01
影响因子：
9.8
通讯作者：
Hirano, Ikuo
中科院分区：
文献类型：
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作者：
Shah, Ameesh A.;Kagalwalla, Amir F.;Hirano, Ikuo
目的：嗜酸性粒细胞性食管炎（EoE）的诊断基于有食管症状的患者食管鳞状上皮中嗜酸性粒细胞增多的组织学表现。鳞状上皮嗜酸性粒细胞浸润程度的变异性对诊断准确性提出了挑战。我们检查了一组明确的 EoE 儿童的组织病理学特征，以获得诊断所需的最佳活检数量。方法：对根据每个高倍视野 (eos/HPF) > 15 个嗜酸性粒细胞数诊断为 EoE 的总共 30 名患者进行了评估。 EoE 的诊断基于抑酸治疗后食管持续嗜酸性粒细胞增多。所有患者均采集了中段和远端活检标本，并进行了 24 小时 pH 探针研究分析。 结果：共审查了 221 份活检标本，平均每位患者 7.8 份（范围为 5-8 份）标本。 8 名患者的 pH 值研究显示异常。中位 eos/HPF 为 41（范围：0-288 eos/HPF）。使用 > 15 eos/HPF 的标准，单次活检的诊断灵敏度为 73%，两次、三次和六次活检的诊断灵敏度分别增至 84%、97% 和 100%。如果仅从食管中部进行活检，则有 5 名患者 (17%) 不符合诊断标准，而如果仅分析远端活检，则有 1 名患者 (3%) 会被漏诊。 结论：EoE 儿科患者的活检标本存在显着的组织学变异。使用 > 15 eos/HPF 的标准，三个活检标本对 97% 的患者进行了 EoE 诊断。当患有 EoE 和胃食管反流病的患者接受质子泵抑制剂治疗后，与 EoE 一致的组织病理学变化可能持续存在，而后者的定义是远端食管酸暴露增加。
OBJECTIVES: The diagnosis of eosinophilic esophagitis (EoE) is based on histologic findings of eosinophilia in the esophageal squamous epithelium in patients presenting with esophageal symptoms. Variability in the degree of squamous epithelial eosinophil infiltration presents a challenge to diagnostic accuracy. We examined the histopathologic features in a well-defined cohort of children with EoE to derive an optimal number of biopsies needed for diagnosis.METHODS: A total of 30 patients diagnosed with EoE based on > 15 eosinophils per high-power field (eos/HPF) were evaluated. The diagnosis of EoE was based on persistent esophageal eosinophilia following acid suppression therapy. All patients had mid and distal biopsy specimens that were analyzed along with 24-h pH probe studies.RESULTS: A total of 221 biopsy specimens were reviewed with a median of 7.8 (range, 5-8) specimens per patient. Eight patients demonstrated abnormal pH studies. The median eos/HPF was 41 (range, 0-288 eos/HPF). Using a criterion of > 15 eos/HPF, the diagnostic sensitivity of a single biopsy was 73%, which increased to 84%, 97% and 100% for two, three and six biopsies, respectively. Five patients (17%) would not have met the criteria for diagnosis if biopsies were only taken from the mid esophagus whereas one patient (3%) would have been missed if only distal biopsies were analyzed.CONCLUSIONS: Significant histologic variability exists among biopsy specimens from pediatric patients with EoE. Using the criterion of > 15 eos/HPF, three biopsy specimens achieved a diagnosis of EoE in 97% of patients. Histopathologic changes consistent with EoE can persist following proton pump inhibitor therapy in patients with EoE and gastroesophageal reflux disease when the latter is defined by increased distal esophageal acid exposure.