Salek J, Clayton F, Vinson L, Saffari H, Pease L F, Boynton K, Fang J, Cox K, Peterson K A
Department of Internal Medicine, Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA.
Department of Surgical Pathology, University of Utah, Salt Lake City, UT, USA.
Aliment Pharmacol Ther. 2015 Jun;41(12):1288-95. doi: 10.1111/apt.13201. Epub 2015 Apr 21.
Acknowledging that eosinophilic esophagitis (EoE) is a disease with variable involvement throughout the oesophagus, studies have suggested a minimum of five biopsies to diagnose EoE. Although it is accepted that furrows and exudates appear to represent areas of inflammation, no research to date has looked specifically at EoE endoscopic findings to see if eosinophilic infiltrate correlates with specific endoscopic findings.
To evaluate the distribution of eosinophils in EoE and determine whether endoscopic appearances predict the degree of eosinophilia at various locations of the oesophagus.
We performed a prospective cross sectional study of EoE (treated and untreated) patients to study the distribution of eosinophils according to endoscopic findings. The oesophagus of 10 EoE patients were biopsied up to 32 times in a circumferential manner. The mucosal changes were documented at the site of each biopsy. Histological determination of eosinophil counts and related histopathology of the oesophagus were then correlated with endoscopic findings. Similar biopsy assessments were made in treated (resolved) EoE patients (n = 6) to determine the permanence of specific endoscopic appearances.
A total of 16 patients were biopsied (10 EoE, 6 treated EoE). A total of 432 biopsies were obtained in all with 294 biopsies from 10 EoE subjects. Eosinophil density was increased distally in the majority of EoE patients. Biopsies performed in areas of exudates and furrows demonstrated higher eosinophil counts. Lines and normal-appearing oesophagi in EoE subjects were not commonly associated with elevated eosinophil counts (>15 eos/HPF). Rings alone without associated furrows or plaques did not demonstrate elevated eosinophil counts and were seen in resolved EoE (Rx-EoE) as well as in active EoE patients.
Eosinophilic esophagitis remains a variable disease with some patients manifesting extensive disease throughout the oesophagus. Characteristics of furrows and exudates found during endoscopy are associated with higher peak eosinophil counts, requiring fewer biopsies to make a diagnosis. Lines and otherwise normal appearances of the oesophagus suggest a milder mucosal eosinophilia, requiring substantial biopsies to adequately identify fields with diagnostic eosinophil counts.
认识到嗜酸性粒细胞性食管炎（EoE）是一种食管受累情况多变的疾病，研究表明至少需要五次活检才能诊断EoE。尽管人们公认皱襞和渗出物似乎代表炎症区域，但迄今为止尚无研究专门观察EoE的内镜检查结果，以确定嗜酸性粒细胞浸润是否与特定的内镜检查结果相关。
评估EoE中嗜酸性粒细胞的分布，并确定内镜表现是否能预测食管不同部位的嗜酸性粒细胞增多程度。
我们对EoE（治疗和未治疗）患者进行了一项前瞻性横断面研究，以根据内镜检查结果研究嗜酸性粒细胞的分布。对10例EoE患者的食管进行了多达32次的环周活检。在每次活检部位记录黏膜变化。然后将食管嗜酸性粒细胞计数的组织学测定及相关组织病理学与内镜检查结果进行关联。对治疗（缓解）的EoE患者（n = 6）进行了类似的活检评估，以确定特定内镜表现的持久性。
总共对16例患者进行了活检（10例EoE，6例治疗后的EoE）。总共获得了432次活检，其中10例EoE患者有294次活检。大多数EoE患者远端的嗜酸性粒细胞密度增加。在渗出物和皱襞区域进行的活检显示嗜酸性粒细胞计数更高。EoE患者中的线条样改变和外观正常的食管通常与嗜酸性粒细胞计数升高（>15个嗜酸性粒细胞/高倍视野）无关。单独的环而无相关皱襞或斑块者，嗜酸性粒细胞计数未升高，在缓解的EoE（Rx-EoE）以及活动性EoE患者中均可见到。
嗜酸性粒细胞性食管炎仍然是一种多变的疾病，一些患者在整个食管中表现出广泛的病变。内镜检查中发现的皱襞和渗出物特征与较高的嗜酸性粒细胞峰值计数相关，诊断所需的活检次数较少。食管的线条样改变和其他正常表现提示黏膜嗜酸性粒细胞增多较轻，需要进行大量活检才能充分识别具有诊断性嗜酸性粒细胞计数的区域。
