title: Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis.
abstract: BACKGROUND
  Recently recognized as an important cause of dysphagia and food impaction in adults, eosinophilic esophagitis (EE) is diagnosed by histologic findings of increased mucosal eosinophils.
  
  
  OBJECTIVE
  We examined variability in histopathologic features of adults with EE to derive a recommendation on the optimal number and location of biopsies needed for diagnosis.
  
  
  METHODS
  Charts were reviewed from 74 patients diagnosed with EE based on > or =15 eosinophils per high-power field (eos/hpf). Biopsy specimens were prospectively analyzed for the degree of eosinophilia and histopathologic features of EE. Subgroup analysis was performed in patients with biopsy specimens from both the proximal and the distal esophagus. The biopsy specimens from patients with EE were compared with specimens from biopsied Schatzki's ring.
  
  
  METHODS
  Northwestern University Feinberg School of Medicine.
  
  
  METHODS
  Charts were reviewed for 74 adult patients and biopsy specimens were available for 66 patients.
  
  
  RESULTS
  A total of 341 biopsy specimens from 66 patients were available for analysis and revealed marked variability within and between biopsy specimens of individual patients. The median eos/hpf was 107 (0-557 eos/hpf). By using criteria of > or =15 eos/hpf for diagnosis, we found that 1 biopsy specimen had a sensitivity of 55%, which increased to 100% after 5 biopsies. By using stricter criteria, additional biopsy specimens were needed to achieve 100% sensitivity. Despite a higher eosinophilia in distal (82 eos/hpf) compared with proximal biopsy specimens (68 eos/hpf), this difference was not statistically significant. There was marked difference between eosinophilia in mucosal biopsy specimens of patients with EE (82 eos/hpf) compared with Schatzki's ring (0.3 eos/hpf).
  
  
  CONCLUSIONS
  Significant histologic variability exists among biopsy specimens from individual patients with EE and necessitates multiple biopsies to improve diagnostic sensitivity. No significant difference in eosinophilia was demonstrated between proximal and distal sites.
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Gonsalves
authors.forename: Maria
authors.initials: M
authors.lastname: Policarpio-Nicolas
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.forename: M Sambasiva
authors.initials: MS
authors.lastname: Rao
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hirano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D003680:Deglutition Disorders / Q000209:etiology; D004802:Eosinophilia / Q000150:complications / Q000473:pathology*; D004804:Eosinophils; D004941:Esophagitis / Q000209:etiology / Q000473:pathology*; D004947:Esophagus / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000276:immunology / Q000473:pathology; D012680:Sensitivity and Specificity