title: High intraepithelial eosinophil counts in esophageal squamous epithelium are not specific for eosinophilic esophagitis in adults.
abstract: OBJECTIVE
  The histologic criterion of >20 eosinophils per high power field (hpf) is presently believed to establish the diagnosis of idiopathic eosinophilic esophagitis (IEE). This is based on data that the number of intraepithelial eosinophils in gastroesophageal reflux disease (GERD) is less than 20/hpf. This study tests this belief.
  
  
  METHODS
  Pathology records were searched for patients who had an eosinophil count >20/hpf in an esophageal biopsy. This patient population was biased toward adults with GERD who had routine multilevel biopsies of the esophagus. The clinical, radiological, and manometric data and biopsies were studied.
  
  
  RESULTS
  Forty patients out of a total of 3,648 reports examined had an eosinophil count >20/hpf in squamous epithelium of an esophageal biopsy. Analysis of these 40 cases indicated that 6 (15%) patients had IEE, 2 (5%) had coincident IEE and GERD, 28 (70%) had GERD, and 2 (5%) each had achalasia and diverticulum. There was no significant difference among these groups in terms of maximum eosinophil number, biopsy levels with >20 esoinophils/hpf, presence of eosinophilic microabscesses, involvement of surface layers by eosinophils, and severity of basal cell hyperplasia and dilated intercellular spaces.
  
  
  CONCLUSIONS
  All histologic features presently ascribed to IEE can occur in other esophageal diseases, notably GERD. As such, the finding of intraepithelial eosinophilia in any number is not specific for IEE. When a patient with GERD has an esophageal biopsy with an eosinophil count >20/hpf, it does not mean that the patient has IEE.
authors.affiliation: Department of Surgical Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Sonali
authors.initials: S
authors.lastname: Rodrigo
authors.forename: Gebran
authors.initials: G
authors.lastname: Abboud
authors.forename: Daniel
authors.initials: D
authors.lastname: Oh
authors.forename: Steven R
authors.initials: SR
authors.lastname: DeMeester
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hagen
authors.forename: John
authors.initials: J
authors.lastname: Lipham
authors.forename: Tom R
authors.initials: TR
authors.lastname: DeMeester
authors.forename: Parakrama
authors.initials: P
authors.lastname: Chandrasoma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004802:Eosinophilia / Q000150:complications* / Q000473:pathology*; D004804:Eosinophils; D004848:Epithelium / Q000473:pathology; D004935:Esophageal Diseases / Q000150:complications / Q000473:pathology; D004941:Esophagitis / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged