Surface Hyaline Keratosis Is a Highly Significant Marker of Reflux vs. Eosinophilic Esophagitis: A Multivariate Analysis Study.
Alexandros D Polydorides, Mirna Chehade, Mohammad Raoufi, Noam Harpaz. Mt Sinai School of Medicine, New York, NY
Background: Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) are distinct clinicopathologic entities with overlapping clinical, endoscopic and histologic findings but different management approaches. Although certain histologic features may favor one diagnosis, inadequate specificity and poorly standardized criteria often result in uncertainty. We evaluated putative histologic aids in this distinction including surface hyaline keratosis (SHK), a feature that had hitherto received little attention.
Design: Retrospectively identified consecutive patients (n=216) with esophageal biopsies were divided into 3 groups: (1) GERD (n=63): typical GERD symptoms/endoscopic findings (heartburn, vomiting, hiatal hernia, erosion/ulcer) and concordant histology (basal hyperplasia, papillomatosis, blood lakes, <15 intraepithelial eosinophils/HPF); (2) EoE (n=62): typical EoE symptoms/endoscopic findings (food allergy, atopy, asthma, food impaction, peripheral eosinophilia, esophageal furrows/rings) and concordant histology (>20 intraepithelial eosinophils/HPF with superficial distribution/degranulation/microabscesses, submucosal fibrosis); (3) uncertain (n=91): discordant clinical, endoscopic and histologic findings. H&E sections were blindly and semiquantitatively graded for 16 histological features including SHK, defined as a surface layer of hypereosinophilic squamous epithelium ≥3 cells thick devoid of inflammation, erosion or ulcer.
Results: In univariate analysis, features significantly more common in EoE vs. GERD included eosinophil degranulation (p<0.001), microabscesses (p<0.001) and superficial distribution (p<0.001), lamina propria fibrosis (p=0.05) and higher mean lamina propria eosinophils (p=0.002). GERD cases had more frequent squamous ballooning (p<0.001), blood lakes (p<0.001), neutrophils (p=0.04) and SHK (21% vs. 2%; p=0.006). In multivariate logistic regression of these variables, SHK emerged with the highest odds ratio (>104) followed by blood lakes and eosinophil degranulation. In the uncertain group, SHK was present in 17 (19%) cases. Clinical post-biopsy follow-up by an EoE specialist revealed that 10 (59%) of these cases could be classified as GERD, 2 as EoE and 1 as EoE with possible GERD overlap; follow-up could not be obtained in 4 cases.
Conclusions: SHK, when strictly defined, is a histologic marker significantly associated with GERD that may be useful in discriminating it from EoE when other clinical, endoscopic, and histologic features are inconclusive.
Monday, February 28, 2011 1:00 PM
Poster Session II # 80, Monday Afternoon