Department of Pathology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pathology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Gastrointest Endosc. 2018 May;87(5):1207-1214.e3. doi: 10.1016/j.gie.2017.12.020. Epub 2018 Jan 5.
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.
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.
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 = .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.
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.
在嗜酸粒细胞性食管炎（EoE）中，仅在具有足够固有层（LP）的食管活检标本中才能检测到黏膜下纤维化。我们研究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获取率。
我们评估了 39 例 EoE 患者的 284 份食管活检标本和 32 例无食管嗜酸性粒细胞增多或其他食管异常的患者的 87 份活检标本，以评估是否存在足够的 LP 和纤维化。
以每份活检标本为基础，EoE 患者与无食管嗜酸性粒细胞增多或其他食管异常的患者获取足够 LP 的比例无显著差异（43% vs 31%，P =.14）。85%的 EoE 患者有纤维化。EoE 患者的纤维化呈斑片状，更可能发生在食管中段或远端（比值比，19.93；95%置信区间，4.12-91.52）。在有纤维化的患者中，7 份中-远端食管活检标本的检出率达到>95%。尽管表现为仅炎症性内镜特征，大多数新诊断的 EoE 患儿已经存在黏膜下纤维化。
大多数儿童的单个食管活检标本不足以评估黏膜下纤维化，且 EoE 患者和无 EoE 患者每份活检标本获取足够 LP 的比例相似。为了可靠地检测 EoE 患者的纤维化，至少应从中-远端食管采集 7 份活检标本。在新诊断的 EoE 患儿中发现纤维化且仅有炎症性内镜特征，提示纤维化可能在该病早期发生。
