title: Low grade esophageal eosinophilia in adults: an unrecognized part of the spectrum of eosinophilic esophagitis?
abstract: BACKGROUND
  Eosinophilic esophagitis (EoE) is defined by a minimum of 15 eosinophils (eos) per high-powered field (HPF) on esophageal biopsy, along with esophageal symptoms and the exclusion of gastroesophageal reflux (GERD). The clinical significance of fewer eosinophils is unknown.
  
  
  METHODS
  Fifty-nine adult patients without a previous diagnosis of EoE with esophageal biopsies containing 1-14 eos per HPF (low grade eosinophilia) and 418 adult patients with ≥15 eos per HPF were identified by retrospective review. Patients were divided into group A (1-9 eos per HPF), group B (10-14 eos per HPF), and group C (≥15 eos per HPF) with a chart review of clinical and demographic data.
  
  
  RESULTS
  While dysphagia and atopy (asthma and allergic rhinitis) were more common in patients with ≥15 eos per HPF (group C) than those with low grade esophageal eosinophilia (groups A and B) (93 vs. 88%, P = 0.02), food impaction and heartburn occurred at an equal frequency across all patient groups. Endoscopic findings were likewise similar between groups. Of the 14 patients with low grade esophageal eosinophilia who underwent repeat endoscopy a mean interval of 42 weeks (range 8-118 weeks) later, five (36%) met conventional diagnostic criteria for EoE of 15 or greater eos per HPF. Follow-up in ten patients treated with topical corticosteroids noted improvement in nine, with mean follow-up of 8 weeks (range 4-12 weeks).
  
  
  CONCLUSIONS
  Some adult patients with dysphagia and less than 15 eos per HPF have similar endoscopic findings and clinical course to patients meeting the consensus definition of EoE. Further evaluation of patients with low grade esophageal eosinophilia is needed.
authors.affiliation: Division of Gastroenterology & Hepatology, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ravi
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Talley
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.forename: Lori
authors.initials: L
authors.lastname: Kryzer
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Romero
authors.forename: Amindra S
authors.initials: AS
authors.lastname: Arora
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000097:blood / Q000188:drug therapy; D003680:Deglutition Disorders / Q000097:blood / Q000188:drug therapy; D004724:Endoscopy; D057765:Eosinophilic Esophagitis / Q000097:blood* / Q000188:drug therapy / Q000473:pathology*; D004804:Eosinophils / Q000473:pathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000097:blood / Q000473:pathology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000097:blood / Q000188:drug therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones