Clinicopathological Differences between Eosinophilic Esophagitis and Asymptomatic Esophageal Eosinophilia

Abstract

Objective According to consensus guidelines, eosinophilic esophagitis (EoE) is defined as a clinicopathological entity whose symptoms and histology must always be considered together. However, endoscopic findings typical of EoE are often seen in asymptomatic esophageal eosinophilia (aEE). We aimed to clarify the clinicopathological features of aEE. Methods We retrospectively compared cases of aEE and those of symptomatic EoE. Patients or MaterialsWe reviewed 146 patients who underwent upper gastrointestinal endoscopy and were confirmed histopathologically to have esophageal eosinophil infiltration of at least 15 eosinophils per highpower field. They were divided into the aEE group (n=75) and the EoE group (n=71). Patients' clinicopathological findings were then collected and examined. ResultsThe EoE group experienced dysphagia (47.9%), heartburn (40.8%), food impaction (40.8%), chest pain (16.9%), and other symptoms (8.5%). There was no significant difference between the two groups with regard to age, sex, current smoking status, or alcohol consumption. The aEE group had a significantly higher body mass index (p<0.01) and significantly lower frequency of concurrent allergic diseases (p<0.01) than the EoE group. No significant differences were found between the two groups with regard to the mean peripheral blood eosinophil count, non-specific immunoglobulin E concentration, peak eosinophil infiltration in the biopsy specimens, EoE histology scoring system, phenotype and location of typical endoscopic findings of EoE, or thickness of the esophagus wall or the mucosal and submucosal layer as measured by endoscopic ultrasonography. Two patients in the aEE group who were followed up without treatment subsequently developed esophageal symptoms. Conclusions aEE and EoE may have the same clinicopathological features.

Eosinophilic oesophagitis in Denmark: Population‐based incidence and prevalence in a nationwide study from 2008 to 2018

“…We did not use the diagnosis code DK20.9D for EoE in the current study, as it was introduced in Denmark as late as 2014, and still not routinely used. Furthermore, recent studies have reported on asymptomatic oesophageal eosinophilia (aEE), which has endoscopic and histological findings similar to those of EoE, but does not have oesophageal dysfunction 28,29 . EoE and aEE may have the same pathogenesis, but it is still unclear if aEE should be treated or not, and further investigation is needed 29 .…”

“… 28 , 29 EoE and aEE may have the same pathogenesis, but it is still unclear if aEE should be treated or not, and further investigation is needed. 29 When using the broad definition, we may include patients with aEE, although most of the patients undergoing an upper gastrointestinal endoscopy will have upper gastrointestinal symptoms as an indication for the procedure. A limitation of our study is that in the cases where no symptoms were registered, we cannot know if the patients were truly asymptomatic or whether symptoms were not registered by the physician.…”

“…Prevalence of oesophageal eosinophilia (EoE) in Denmark 2008-2018 using the broad definition of EoE, that is EoE with no alternative cause of oesophageal eosinophilia. (a) Prevalence of EoE stratified by age groups, (b) Prevalence of EoE stratified by sex, and (c) Prevalence of EoE stratified by region histological findings similar to those of EoE, but does not have oesophageal dysfunction 28,29. EoE and aEE may have the same pathogenesis, but it is still unclear if aEE should be treated or not, and further investigation is needed 29.…”

“…(a) Prevalence of EoE stratified by age groups, (b) Prevalence of EoE stratified by sex, and (c) Prevalence of EoE stratified by region histological findings similar to those of EoE, but does not have oesophageal dysfunction 28,29. EoE and aEE may have the same pathogenesis, but it is still unclear if aEE should be treated or not, and further investigation is needed 29. When using the broad definition, we may include patients with aEE, although most of the patients undergoing an upper gastrointestinal endoscopy will have upper gastrointestinal symptoms as an indication for the procedure.…”

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.…”