Esophageal intraepithelial eosinophils in dysphagic patients with gastroesophageal reflux disease.
BACKGROUND
Patients with gastroesophageal reflux disease (GERD) often complain of dysphagia and are frequently found to have intraepithelial eosinophils on esophageal biopsy.


OBJECTIVE
The aim of this study was to investigate the relationship between dysphagia and the number of intraepithelial eosinophils in patients with GERD.


METHODS
Review of all patients studied in our esophageal function laboratory from 1999 to 2007 identified 1,533 patients with increased esophageal acid exposure. Patients who complained of dysphagia without mechanical or motor causes were identified and divided into three groups based on whether dysphagia was their primary, secondary or tertiary symptom. A control group consisted of randomly selected GERD patients with no dysphagia. The highest number of intraepithelial eosinophils per high-power field (HPF) in biopsies from the squamocolumnar junction (SCJ) and esophageal body was compared across groups.


RESULTS
There were 71 patients with unexplained dysphagia. Dysphagia was the primary symptom in 13 (18%), secondary symptom in 34 (48%), and tertiary symptom in 24 (34%) patients. The number of eosinophils differed between the four groups, with the highest number in those with dysphagia as the primary symptom (P = 0.0007). This relationship persisted whether biopsies were from the SCJ (P = 0.0057) or esophageal body (P = 0.0096).


CONCLUSIONS
An association exists between the number of intraepithelial eosinophils and dysphagia in GERD patients, with the highest number of eosinophils in those with the primary symptom of dysphagia.
Ayazi
Shahin
S
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Hagen
Jeffrey A
JA
Chandrasoma
Parakrama
P
Gholami
Parviz
P
Zehetner
Joerg
J
Oezcelik
Arzu
A
Lipham
John C
JC
Demeester
Steven R
SR
Demeester
Tom R
TR
Kline
Michael M
MM
D000328:Adult; D000368:Aged; D001706:Biopsy; D003680:Deglutition Disorders / Q000473:pathology*; D004802:Eosinophilia / Q000473:pathology*; D004804:Eosinophils / Q000473:pathology; D004848:Epithelium / Q000473:pathology; D004942:Esophagitis, Peptic / Q000473:pathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000473:pathology*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012307:Risk Factors