Looking Twice for Eosinophilic Esophagitis

Not only do you have to take a lot of esophageal biopsies, now you may need to call your pathologist to make sure you do not miss a case of eosinophilic esophagitis (EoE), especially if there are mildly increased eosinophils.  At least, that’s the message I inferred from a recent study (Rothenberg ME, et al. JPGN 2015; 61: 65-8).

In this study, the researchers identified 477 biopsies from 429 patients with EoE; 316 were from “PPI confirmed patients.”

Key finding: Of the 477 biopsies, 106 had a peak count of between 1 and 14 eos/hpf cited in the pathology report.  However, 23/106 (22% with 1-14 eos/hpf) had ≥15 esos/hpf after a second review.

Overall, 5% of the 477 biopsies were mischaracterized as not meeting the threshold of ≥15 esos/hpf prior to review.  Given this frequency at a major medical center and frequent referral center for EoE, my suspicion is that the yield of a 2nd look would be at least as high in most other centers.

Take-home point: Look twice for EoE if eosinophil count is between 1/hpf and 14/hpf. Maybe some new diagnoses are being missed and maybe some of your EoE patients in histologic remission really aren’t.

Related blog posts:

Grand Tetons from Jenny Lake

Grand Tetons from Jenny Lake

5 thoughts on “Looking Twice for Eosinophilic Esophagitis

  1. Pingback: Eosinophilic Esophagitis Review -NEJM | gutsandgrowth

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  3. Pingback: Eosinophilic Esophagitis: the Limits of “Clinical Remission” | gutsandgrowth

  4. Pingback: Best Approach for Identifying Eosinophilic Esophagitis | gutsandgrowth

  5. Pingback: 4-14-4 Rule: More Biopsies Needed For Eosinophilic Esophagitis | gutsandgrowth

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