Inform Diagnostics, Irving, Texas, USA.
Baylor College of Medicine, Houston, Texas, USA.
Aliment Pharmacol Ther. 2022 Jul;56(2):240-250. doi: 10.1111/apt.16971. Epub 2022 May 12.
Non-oesophageal gastrointestinal eosinophilic diseases (EGID) are considered rare. However, low disease awareness among clinicians and pathologists may contribute to underdiagnosis.
To determine how frequently requests to evaluate for EGID accompany gastrointestinal biopsies and in what proportion of suspected cases pathologists address these requests, either confirming or refuting the clinical suspicion.
All cases in which biopsy requisitions included an explicit suspicion of EGID were extracted from a large clinicopathologic database and manually reviewed for accuracy. The diagnoses for these cases were then analysed to determine whether clinical suspicions were confirmed, refuted or ignored.
Eosinophilic oesophagitis (EoE) was suspected in 12.8% of 903,516 patients with biopsies and confirmed in 14.9% of them. A suspicion of eosinophilic gastritis accompanied <0.001% of 1,438,206 gastric biopsy sets and was confirmed in 11.5% of them; eosinophilic duodenitis was suspected in 0.02% of ~675,519 patients with duodenal biopsies and confirmed in 8.0% of these; eosinophilic colitis was mentioned in <0.001% of 2,504,485 patients with colonic biopsies and confirmed in 0.1% of them. Less than 3% of endoscopists mentioned non-oesophageal EGID in the requisition, while most expressed a clinical suspicion of Barrett oesophagus, Helicobacter pylori gastritis, celiac disease and microscopic colitis (in 21.2%, 49.2%, 1% and 6.4% of the cases, respectively).
Gastroenterologists and pathologists commonly address and diagnose EoE. In contrast, both clinical suspicion and diagnosis of non-oesophageal EGID are extremely rare. Increased clinical awareness might result in a better understanding of the epidemiology and improved diagnosis of these still elusive conditions.
非食管胃肠道嗜酸性粒细胞疾病（EGID）被认为较为罕见。然而，临床医生和病理学家对该病的认识不足可能导致漏诊。
确定在胃肠道活检中，有多少比例的请求是为了评估 EGID，以及病理学家在多大比例的疑似病例中满足了这些请求，无论是确认还是否定临床怀疑。
从一个大型临床病理数据库中提取了所有活检申请中明确怀疑 EGID 的病例，并进行了手动复查以确保准确性。然后分析这些病例的诊断结果，以确定临床怀疑是得到了证实、否定还是被忽视。
嗜酸性食管炎（EoE）在 903516 例接受活检的患者中被怀疑的比例为 12.8%，其中 14.9%得到了证实。怀疑嗜酸细胞性胃炎的比例<0.001%（1438206 例胃活检中），其中 11.5%得到了证实；嗜酸细胞性十二指肠炎在 675519 例十二指肠活检患者中被怀疑的比例为 0.02%，其中 8.0%得到了证实；嗜酸细胞性结肠炎在 2504485 例结肠活检患者中被提及的比例<0.001%，其中 0.1%得到了证实。不到 3%的内镜医生在申请中提到非食管 EGID，而大多数医生表达了对 Barrett 食管、幽门螺杆菌胃炎、乳糜泻和显微镜下结肠炎的临床怀疑（分别占病例的 21.2%、49.2%、1%和 6.4%）。
胃肠病学家和病理学家通常会诊断 EoE。相比之下，非食管 EGID 的临床怀疑和诊断都极为罕见。提高临床认识可能会更好地了解这些仍然难以捉摸的疾病的流行病学，并改善对这些疾病的诊断。
