High Intraepithelial Eosinophil Counts in Esophageal Squamous Epithelium Are Not Specific for Eosinophilic Esophagitis in Adults

Abstract

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.

Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis

“…4 However, newer data suggest that the differentiation between GERD and allergic mediated OEI cannot be made on density of eosinophilic infiltrate alone, 5 especially when a cut-off of ‡15 eos ⁄ hpf is used. 6,7 The distinction between GERD or allergy-induced OEI has become so important that the most recent consensus statements 4,8 on the diagnostic criteria of eosinophilic oesophagitis requires that GERD be ruled out either by a lack of symptomatic and histological response to acid suppression or a negative pH study. Despite the important endorsement of pH monitoring in these patients, there is little data prospectively evaluating the ability of a positive or negative ambulatory pH study to predict reliable response to either acid suppressing or steroid therapy respectively.…”

“…Based on previous studies, we believed the likely proportion would be approximately 50%. 7,12,13 We determined that a sample size of 50 patients would provide a 95% confidence interval of 36-64%.…”

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

“…In patients with dysphagia, esophageal biopsies are generally recommended in order to rule out eosinophilic esophagitis. However, it is not uncommon to find an increased number of eosinophils in patients with achalasia secondary to inflammatory process related to stasis (20,21). More than that, motility disorders may be found in up to 25% patients with eosinophilic esophagitis, ineffective esophageal motility being the most common finding (22).…”

Histomorphological and immunophenotypic features of pill-induced esophagitis

“…'Reactive atypia' was considered when a squamous epithelial cell had a vesicular nucleus and a prominent nucleolus. The thickening of basal layer was rated as normal: < 25% of total epithelial thickness, mild thickening: 25~50%, and marked: >50% [15][16][17]28].…”

“…Reflux esophagitis and eosinophilic esophagitis are the more well-recognized disease entities involving intraepithelial eosinophilic infiltration [14][15][16][17]. Additionally, esophageal ulceration is commonly observed in pill-induced and reflux esophagitis.…”