Role of Reflux on Eosinophilic Esophagitis: Analysis on Morphologic Feature, Classification and Clinical Correlation with Large Cohort of 273 Patients.
Purabi Dhakras, Deepa Patil, Sambasiva Rao, Nirmala Gonsalves, Ikuo Hirano, Guan-Yu Yang. Northwestern University, Chicago, IL
Background: In adults, eosinophilic esophagitis (EE) is an increasingly recognized disorder. The etiology and pathogenesis is less well defined, probably idiopathic or associated with food allergens.Although, reflux is an important factor involved in the pathogenesis of EE, the definitive role of reflux in EE is not clear, whether a triggering or promoting factor. In the present study, we analyzed a large cohort of 273EE cases to determine the effect of reflux and PPI therapy on EE, mainly focusing on their a)morphological features b)comparison between distalEE and reflux esophagitis andc) correlation of distal predominant EE and diffuse pattern EE with PPI theraupetic effect.
Design: The diagnostic criterion for EE was 15eos/hpf in>3-5 fields or single hpf with>25 intraepithelial eosinophils in at least one biopsy fragment. All of the EE specimens were further classified as proximal predominant,distal predominant and diffuse type (identified in both distal and proximal esophagus). Age, basal cell hyperplasia(BCH) (normal:25%,mild:26-50%,moderate:51-75%,severe>75%), spongiosis/intercellular edema, and ballooning epithelial change (focal/diffuse) were also analyzed.
Results: 546 biopsies from 273 patients(185males,88females) diagnosed as EE were studied, including 188distal,3proximal,and 82diffuse type.Increasing numbers of eosinophils were significantly associated with increasing severity of BCH and spongiosis(p<0.001forboth). Epithelial ballooning change was noted predominantly in reflux (>50%inRE,n=20);but only in 12%distal predominant and nearly 7% in diffuseEE (p<0.001). 40 cases of these EE patients were treated with PPI for two months after diagnosis, including 31diffuse, 6distal and 3 proximal type. Morphologically,66% of both diffuse type and distal predominant EE showed significant reduction of eosinophilic infiltrate after PPI treatment(p<0.05).The maximum count of 50eos/hpf and 100eos/hpf in proximal and distal biopsies, respectively,decreased to 4eos/hpf in both biopsies post treatment. In addition,BCH and spongiosis showed a significant decrease in proximal(p=0.02), and marked decreased in distal biopsies(p=0.06).
Conclusions: Our results indicate epithelial ballooning change is a key histological feature that distinguishes RE from EE, and PPI therapy significantly improves EE morphologically in at least 2/3 cases regardless of distal type or diffuse pattern of EE. The results further imply that reflux plays a significant role in the pathogenesis of EE.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 91, Monday Morning