title: Eosinophils in the oesophageal mucosa: clinical, pathological and epidemiological relevance in children: a cohort study.
abstract: Objectives Eosinophilic oesophagitis (EO) shows eosinophilic infiltration of the mucosa and can present with symptoms indistinguishable from gastrooesophageal reflux disease (GORD). The authors describe the clinical, endoscopic and histopathological features of all cases of histological EO presenting during 2007-2008 with a 2-year follow-up. The incidence of paediatric EO and the features of a subgroup with features of both GORD and EO ('overlap' syndrome (OS)) are described.  Design Biopsies with an average of 15 eosinophils/high-power field (HPF) were reviewed in the cohort. OS was suggested when there was coexistence of clinical and histological features of EO and GORD (abnormal pH study), which improved with proton pump inhibitors.  Setting Tertiary care.  Participants All cases with ≥15 eosinophils/HPF entered the study.  Primary outcome measures Patients with EO had an average of 15 eosinophils/HPF.  Secondary outcome measures Other histological features of EO included microabscesses, dilated intercellular spaces, basal cell hyperplasia, papillary elongation, etc.  Results 24 cases of EO were identified, 13 men and 11 women. The incidence of paediatric oesophageal eosinophilia in the region was 9/100 000 children. 11 of the 24 patients (46%) presented with some form of allergy, six with poor feeding/food aversion, five with dysphagia and four with vomiting. After follow-up, 56.5% were confirmed to have EO, 30.5% responded to treatment for GORD and were categorised as OS, 9% developed eosinophilic gastroenteritis and 4% did not have further upper gastrointestinal symptoms.  Conclusions Accurate diagnosis of EO, especially the differentiation from GORD, requires appropriate clinicopathological correlation. A significant proportion of patients with eosinophilia in the mucosa also have GORD (OS). These patients improve after treating the underlying GORD. The study was registered as a Service Evaluation with the Trust (number SE74).
authors.affiliation: Department of Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
authors.forename: Marta C
authors.initials: MC
authors.lastname: Cohen
authors.forename: Prithviraj
authors.initials: P
authors.lastname: Rao
authors.forename: Mike
authors.initials: M
authors.lastname: Thomson
authors.forename: Mudher
authors.initials: M
authors.lastname: Al-Adnani