Obtaining adequate lamina propria for subepithelial fibrosis evaluation in pediatric eosinophilic esophagitis
Obtaining adequate lamina propria for subepithelial fibrosis evaluation in pediatric eosinophilic esophagitis
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DOI：
10.1016/j.gie.2017.12.020
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发表时间：
2018-05-01
影响因子：
7.7
通讯作者：
Cheng, Edaire
中科院分区：
文献类型：
--
作者：
Wang, Jason;Park, Jason Y.;Cheng, Edaire
背景和目的：嗜酸性粒细胞性食管炎（EoE）中的上皮下纤维化只能在具有足够量固有层（LP）的食管活检标本中检测到。我们调查了儿科食管活检标本中含有足够 LP 的频率，以及食管嗜酸性粒细胞增多是否会影响采集率。方法：我们评估了 39 名 EoE 患者的 284 份食管活检标本，以及 32 名无食管嗜酸性粒细胞或其他食管异常患者的 87 份活检标本，以确定是否存在足够的 LP 和纤维化。结果：在每个活检标本的基础上，患有 EoE 的患者和无食管嗜酸性粒细胞增多的患者之间获得足够量 LP 的比率没有显着差异（43% vs 31%，P Z.14）。 85% 的 EoE 患者患有纤维化。 EoE 患者的纤维化呈斑片状，更有可能在中段或远端食管中检测到（比值比，19.93；95% 置信区间，4.12-91.52）。在纤维化患者中，7份中远端食管活检标本检出率>95%。大多数新诊断的 EoE 儿童尽管仅表现出炎症性内镜特征，但已经患有上皮下纤维化。结论：大多数儿童个体食管活检标本不足以评估上皮下纤维化，并且每个活检标本获得足够 LP 的比率在患有和不患有 EoE 的患者中相似。为了可靠地检测 EoE 患者的纤维化，应从中远端食管中采集至少 7 个活检标本。在新诊断的 EoE 儿童中发现纤维化且仅有炎症内镜特征表明纤维化可能发生在这种疾病的早期。
Background and Aims: Subepithelial fibrosis in eosinophilic esophagitis (EoE) can be detected only in esophageal biopsy specimens with adequate amounts of lamina propria (LP). We investigated how often pediatric esophageal biopsy specimens contain adequate LP, and whether esophageal eosinophilia influences the acquisition rates.Methods: We evaluated 284 esophageal biopsy specimens from 39 patients with EoE, and 87 biopsy specimens from 32 patients without esophageal eosinophilia or other esophageal abnormalities for the presence of adequate LP and fibrosis.Results: On a per biopsy specimen basis, there was no significant difference in the rate of procuring adequate amounts of LP between patients with EoE and patients without esophageal eosinophilia (43% vs 31%, P Z.14). Eighty-five percent of patients with EoE had fibrosis. Fibrosis in patients with EoE was patchy and more likely to be detected in the middle or distal esophagus (odds ratio, 19.93; 95% confidence interval, 4.12-91.52). Among patients with fibrosis, the probability of its detection reached > 95% with 7 middle-distal esophageal biopsy specimens. Most children with newly diagnosed EoE already had subepithelial fibrosis despite exhibiting only inflammatory endoscopic features.Conclusions: Most individual esophageal biopsy specimens in children are inadequate for assessing subepithelial fibrosis, and the rates of procuring adequate LP per biopsy specimen are similar in patients with and without EoE. To reliably detect fibrosis in patients with EoE, at least 7 biopsy specimens should be taken from the middle-distal esophagus. The finding of fibrosis in children with newly diagnosed EoE and only inflammatory endoscopic features suggests that fibrosis can occur early in this disease.