Clinical Features of Esophageal Eosinophilia According to Endoscopic Phenotypes

Abstract

Objective Esophageal eosinophilia (EE), a histological hallmark of eosinophilic esophagitis, is classified into two endoscopic phenotypes: localized and diffuse EE. Our aim was to determine the prevalence of EE localized in the lower esophagus and to describe its clinical features in comparison with diffuse EE. Methods Data from 81 consecutive patients with EE were retrospectively investigated. EE was histologically defined as ≥15 eosinophils per high-power field. Based on the endoscopic appearance with a histological assessment, EE was classified as either diffuse or localized type. We compared the clinical features, including the medical treatment and natural course, between the two types. Results Of the 81 patients, 52 (64.2%) had diffuse EE, and 29 (35.8%) had localized EE. Among men patients, localized EE was significantly more common than diffuse EE. In localized EE, dysphagia and food impaction were less prevalent, and the presence of rings was significantly less common than in diffuse EE. Acid-suppressive therapy was administered to only 3 of the 29 patients with localized EE. In asymptomatic patients, especially those with localized EE, endoscopic abnormalities did not worsen but rather improved in some findings, such as with regard to furrows or exudate, during the natural course of three years without medical treatment. Conclusion Localized EE has a strong predilection for men patients and accounted for more than one third of all cases of EE. This condition appears to be less symptomatic and necessitates milder medical treatment than diffuse EE and might not worsen progressively.

Clinicopathological Differences between Eosinophilic Esophagitis and Asymptomatic Esophageal Eosinophilia

“…The inflammatory and fibrostenotic scores were calculated ( 10 ). Regarding the location of endoscopic findings, the phenotype was divided into diffuse and localized EE in the previous study ( 11 ). The localized type was defined as a small area of EE localized within 1 to 2 cm.…”

Linked color imaging improves the diagnostic accuracy of eosinophilic esophagitis

“…There are some cases in which abnormal findings are localized to a small area at the lower end of the esophagus 31 . We found that the diagnostic ability was much lower in the localized type than in the diffuse type, and there was no diagnostic improvement with the addition of LCI (Table 1).…”

“…EoE was histologically proven to have eosinophilic inflammation, with a peak of more than 15 eosinophils/high‐power field by obtaining more than two biopsy samples. EoE was classified into two subtypes: diffuse type and localized type according to the endoscopic phenotype with histological supporting findings as previously reported 31 Thus, the diffuse type was defined as a widespread area of eosinophilic inflammation involving one or more of three locations: upper, middle, and lower esophagus. Multiple biopsies were obtained from the esophagus for endoscopically suspected diffuse‐type EoE.…”

Endoscopic Diagnosis of Eosinophilic Esophagitis: Basics and Recent Advances

“…Several findings, such as multiple polypoid lesions [ 79 , 80 , 81 ], tug sign/pull sign [ 82 , 83 ], ankylosaurus back sign [ 84 ], and caterpillar sign [ 49 ] have been reported. In addition, endoscopic abnormalities have been localized in small areas of the lower end of the esophagus, or with patchy distribution in 30–40% of patients [ 85 , 86 ] ( Figure 8 ). Such localized types may be missed, unless the whole esophagus is carefully observed with proper expansion by both air inflation and deep inspiration during endoscopy.…”