Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Tennessee Valley Health Care System, Nashville, Tennessee.
Clin Gastroenterol Hepatol. 2021 Sep;19(9):1814-1823.e1. doi: 10.1016/j.cgh.2020.07.035. Epub 2020 Jul 21.
BACKGROUND & AIMS: Esophageal biopsies in children with eosinophilic esophagitis (EoE) are often inadequate for assessment of lamina propria and lamina propria fibrosis (LPF). For children with EoE, little is known about the factors associated with adequate lamina propria (aLP) sampling or the relationship among epithelial features in esophageal biopsies with and without LPF. We aimed to evaluate aLP in esophageal biopsies from children with and without EoE, identify factors associated with aLP and LPF, and examine the relationship among epithelial features in biopsies with and without LPF in children with EoE.
In a retrospective study, we analyzed clinical, endoscopic, and histologic data from 217 children (124 with EoE and 94 without EoE [controls]) using descriptive statistics, logistic regression, Spearman's correlation, and receiver operating characteristic curve analysis. Active and inactive EoE were defined per the 2011 consensus guidelines.
aLP was observed in biopsies from higher proportion of children with EoE (69%) than controls (31%) (P = .0001). Active EoE was independently associated with aLP (adjusted odds ratio [aOR], 4.23; 95% CI, 1.00-18.13; P = .05). Patient sex (aOR for boys, 8.37; 95% CI, 1.23-56.74; P = .03) and peak eosinophil count (aOR, 1.02; 95% CI, 1.01-1.04; P = .01) were independently associated with LPF. Epithelial features were strongly interrelated in biopsies with LPF, and the presence of specific epithelial features was associated with LPF.
aLP was observed in a higher proportion of esophageal biopsies from children with EoE than controls. EoE status, patient sex, and peak eosinophil count were associated with aLP sampling and LPF. Given the intricate relationship between epithelial features and LPF, computational models can be developed to identify children with esophageal biopsies without aLP who are at risk for LPF.
在嗜酸细胞性食管炎（EoE）患儿中，食管活检通常不足以评估固有层和固有层纤维化（LPF）。对于 EoE 患儿，人们对与获得足够固有层（aLP）采样相关的因素以及无 LPF 和有 LPF 的食管活检中上皮特征之间的关系知之甚少。本研究旨在评估 EoE 患儿和无 EoE 患儿（对照组）的食管活检中 aLP 的情况，确定与 aLP 和 LPF 相关的因素，并检查 EoE 患儿有和无 LPF 的活检中上皮特征之间的关系。
在一项回顾性研究中，我们使用描述性统计、逻辑回归、Spearman 相关和受试者工作特征曲线分析，对 217 名儿童（124 名 EoE 患儿和 94 名无 EoE 患儿[对照组]）的临床、内镜和组织学数据进行了分析。根据 2011 年共识指南定义活动期和非活动期 EoE。
EoE 患儿的食管活检中 aLP 的比例（69%）明显高于对照组（31%）（P =.0001）。活动期 EoE 与 aLP 独立相关（调整后的优势比[aOR]，4.23；95%CI，1.00-18.13；P =.05）。患者性别（男孩的 aOR，8.37；95%CI，1.23-56.74；P =.03）和嗜酸性粒细胞计数峰值（aOR，1.02；95%CI，1.01-1.04；P =.01）与 LPF 独立相关。有 LPF 的活检中上皮特征之间存在强烈的相关性，并且特定的上皮特征的存在与 LPF 相关。
EoE 患儿的食管活检中 aLP 的比例明显高于对照组。EoE 状态、患者性别和嗜酸性粒细胞计数峰值与 aLP 采样和 LPF 相关。鉴于上皮特征与 LPF 之间的复杂关系，可以开发计算模型来识别没有 aLP 但有 LPF 风险的食管活检患儿。
