Department of Gastroenterology & Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
Scand J Gastroenterol. 2021 May;56(5):613-620. doi: 10.1080/00365521.2021.1902559. Epub 2021 Apr 9.
According to consensus guidelines, if eosinophilic esophagitis (EoE) is suspected, not only esophageal but also gastric and duodenal biopsy specimens should be sampled in order to exclude other generalized or eosinophilic gastrointestinal (GI) disorders, such as eosinophilic gastroenteritis or celiac disease. However, the diagnostic yield for this remains unclear.
To assess the diagnostic yield of biopsy sampling from the stomach and duodenum in adult EoE patients to rule out generalized or eosinophilic GI disorders.
A retrospective chart-review was conducted in untreated adult EoE patients that underwent upper endoscopy with biopsies sampled from the esophagus, stomach and duodenum. Standardized (electronic) case-report forms were used to extract clinical, endoscopic and histologic data.
In total, 93 adults (71% males, age 36.4 (interquartile range 28.4 - 49.1) years) with untreated EoE (≥15 eosinophils/high-power-field) were included. Symptoms of dysphagia and food impaction were reported in 93% and 58%, respectively of the patients. Typical endoscopic EoE-features were present in 77 (85%) patients. The yield of routinely sampled gastric and duodenal biopsy specimens in our cohort was 3.6% (95% confidence interval: 2.6-4.8%) (n/ = 1/93) for a relevant other generalized or eosinophilic GI diagnosis and 30% for other histological diagnosis such as non-specific or gastritis. In total, 62 (67%) patients presented with other GI symptoms and/or endoscopic abnormalities of the stomach and/or duodenum - which both may be suggestive for other relevant GI conditions. The diagnostic yield for a relevant generalized or eosinophilic GI disorder in this subgroup was, 4.8% (95%CI 3.4 - 6.7%) (n/ = 1/62).
Gastric and duodenal biopsy specimens seem to have limited diagnostic value for the exclusion of generalized or eosinophilic GI disorders in adults with EoE.KEY POINTSEvidence is lacking on the diagnostic value of additional biopsies sampled form the stomach and duodenum to rule out other relevant generalized or eosinophilic gastrointestinal (GI) disorders.The yield of gastric and duodenal biopsies routinely sampled in our cohort was 3.6% for a relevant other generalized or eosinophilic GI diagnosis and 30% for other histological diagnosis such as non-specific or gastritis.The diagnostic yield for a relevant generalized or eosinophilic GI disorder in the subgroup of patients (67%) presenting with other GI symptoms and/or endoscopic abnormalities of the stomach and/or duodenum - which both may be suggestive for other relevant GI conditions was, 4.8%.Gastric and duodenal biopsy specimens seem to have limited diagnostic value for the exclusion of generalized or eosinophilic GI disorders in adults with EoE.
根据共识指南，如果怀疑患有嗜酸性食管炎（EoE），不仅要对食管进行活检，还要对胃和十二指肠进行活检，以排除其他全身性或嗜酸性胃肠道（GI）疾病，如嗜酸性胃肠炎或乳糜泻。然而，目前尚不清楚这种方法的诊断效果。
评估在成人 EoE 患者中进行胃和十二指肠活检以排除全身性或嗜酸性 GI 疾病的诊断效果。
对未经治疗的成年 EoE 患者进行了回顾性图表审查，这些患者接受了上消化道内镜检查，并对食管、胃和十二指肠进行了活检。使用标准化（电子）病例报告表提取临床、内镜和组织学数据。
共纳入 93 名未经治疗的 EoE 患者（71%为男性，年龄 36.4（四分位间距 28.4-49.1）岁）。93%的患者报告有吞咽困难症状，58%的患者报告有食物嵌塞症状。77 名（85%）患者存在典型的内镜 EoE 特征。在我们的队列中，常规采样的胃和十二指肠活检标本的诊断效果为 3.6%（95%置信区间：2.6-4.8%）（n/=1/93），用于诊断其他相关的全身性或嗜酸性 GI 疾病，而对于其他组织学诊断，如非特异性或 胃炎，其诊断效果为 30%。共有 62 名（67%）患者存在其他胃肠道症状和/或胃和/或十二指肠的内镜异常，这些都可能提示存在其他相关的胃肠道疾病。在该亚组中，诊断为其他相关的全身性或嗜酸性 GI 疾病的效果为 4.8%（95%CI 3.4-6.7%）（n/=1/62）。
胃和十二指肠活检对排除成人 EoE 患者的全身性或嗜酸性 GI 疾病的诊断价值有限。
对于排除其他相关的全身性或嗜酸性胃肠道（GI）疾病，额外采样胃和十二指肠组织进行检查的诊断价值尚缺乏证据。
在我们的研究队列中，胃和十二指肠常规采样的诊断效果为：用于诊断其他相关的全身性或嗜酸性 GI 疾病的效果为 3.6%，用于诊断非特异性或 胃炎等其他组织学诊断的效果为 30%。
在存在其他胃肠道症状和/或胃和/或十二指肠内镜异常的患者亚组中（可能提示存在其他相关胃肠道疾病），诊断为其他相关全身性或嗜酸性 GI 疾病的效果为 4.8%。
胃和十二指肠活检对排除成人 EoE 患者的全身性或嗜酸性 GI 疾病的诊断价值有限。
