Luminal Distribution of Eosinophils in Initial Esophageal Biopsies and Symptoms of Reflux at Presentation are Predictive of Response to Inhaled Corticosteroid Treatment in Adult Patients with Eosinophilic Esophagitis
JI Bernstein, DA Katzka, EE Furth. University of Pennsylvania School of Medicine, Philadelphia, PA
Background: The standard management of adult patients with eosinophilic esophagitis (EE) includes inhaled corticosteroids with variable responses to treatment. While enumeration of eosinophils in esophageal biopsies is standard of care for initial diagnosis, the utility of this and other features as predictive markers of treatment response is unknown.
Design: The surgical pathology database of our institution was queried for cases of EE diagnosed between 1998 and 2008. All patients with at least two esophageal biopsies reviewed in that time period were included in the study if the first biopsy available was retrieved prior to initiation of corticosteroid treatment. 120 biopsies from 44 patients were reviewed and the number of eosinophils per high power field (hpf) was quantified for each fragment of tissue obtained. A patient was classified as a responder if one of the patient's biopsies following initiation of treatment had a maximum of 5 eosinophils per hpf. In addition to the microscopic review, patient demographics and endoscopic findings at the time of each biopsy were recorded.
Results: Twenty-nine patients with EE were male and fifteen were female. Their median age was 34 years (range 18 - 57). Seventeen patients (39%) were defined as responders and twenty-seven as non-responders (61%). No difference in age or gender was found between the responders and non-responders, p=.33 and p =.54, respectively. Patients with symptoms of reflux were more likely to respond to treatment (p=.03). No endoscopic findings were significantly correlated with response. Patients with eosinophils concentrated at the luminal surface were more likely to respond to treatment (p=.05). However, there was no significant difference in the maximum number of eosinophils between responders and non-responders (p=.53).
Conclusions: Our results suggest that luminal distribution of eosinophils in initial esophageal biopsies, rather than the concentration or patchiness of these cells, is predictive of response to treatment. In addition, patients complaining of symptoms consistent with reflux at time of presentation are also more likely to respond to inhaled corticosteroids. Thus, the biology of EE may be more diverse than originally thought. These findings have important implications for pathology reporting and patient management.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 88, Monday Morning