title: Oesophageal eosinophilic infiltration in patients with noncardiac chest pain.
abstract: BACKGROUND
  Eosinophilic oesophagitis clinically presents with recurrent episodes of dysphagia and food impaction. Recently, we observed patients with noncardiac chest pain and eosinophilic oesophagitis.
  
  
  OBJECTIVE
  To estimate the prevalence of abnormal eosinophilic infiltration in noncardiac chest pain patients and examine diagnostic utility of demographic, clinical and endoscopic variables to predict eosinophilic oesophagitis.
  
  
  METHODS
  Retrospective study of 171 consecutive patients referred for EGD evaluation of noncardiac chest pain. Endoscopic signs consistent with eosinophilic oesophagitis were recorded. The histological findings were grouped as normal: 0-5 eosinophils/high power field (e/hpf), indeterminate: 6-20 e/hpf, and eosinophilic oesophagitis: ≥21 e/hpf. Abnormal eosinophilic infiltration was defined as ≥6 e/hpf.
  
  
  RESULTS
  Abnormal eosinophilic infiltrate was noted in 24 patients (14%). Thirteen (8%) had indeterminate counts, while 11 (6%) had eosinophilic oesophagitis. Compared with normal, those with abnormal oesophageal eosinophilic infiltration were more likely to be male (71% vs. 34%, P=0.001), have allergies (29% vs. 12%, P=0.050), have current GER symptoms (42% vs. 18%, P=0.013), rings (54% vs. 22%, P=0.002), furrows (21% vs. 1%, P<0.001) and abnormal eosinophilic oesophagitis findings on endoscopy (67% vs. 32%, P=0.001). Of the 24 abnormal patients, 23 (96%) were either male or had rings, furrows, or white specks. Conversely, 68 of 69 patients (99%) who were female did not have rings, furrows, or white specks, and endoscopy was normal. Eight patients (33%) with abnormal eosinophilic infiltration had a normal endoscopy.
  
  
  CONCLUSIONS
  Eosinophilic oesophagitis should be considered in the evaluation of noncardiac chest pain. Our findings suggest that oesophageal biopsies should be obtained particularly in males with recurrent unexplained chest pain, whether endoscopy is normal or abnormal.
authors.affiliation: Gastroenterology Unit, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA. achem.sami@mayo.edu
authors.forename: S R
authors.initials: SR
authors.lastname: Achem
authors.forename: C
authors.initials: C
authors.lastname: Almansa
authors.forename: M
authors.initials: M
authors.lastname: Krishna
authors.forename: M G
authors.initials: MG
authors.lastname: Heckman
authors.forename: H C
authors.initials: HC
authors.lastname: Wolfsen
authors.forename: N J
authors.initials: NJ
authors.lastname: Talley
authors.forename: K R
authors.initials: KR
authors.lastname: DeVault
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology*; D003680:Deglutition Disorders / Q000209:etiology*; D016145:Endoscopy, Digestive System / Q000379:methods; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000175:diagnosis*; D004947:Esophagus / Q000502:physiology*; D005260:Female; D005502:Food; D005547:Foreign Bodies / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012737:Sex Factors