Evaluating the Prognostic Implication of the Collins Histology Scoring System in a Pediatric Eastern Ontario Population With Eosinophilic Esophagitis

Abstract

Introduction: Collins et al developed a histology scoring system (EoE HSS) to assess multiple pathologic features. The aim of this study is to identify if the EoE HSS can better detect endoscopic and symptom improvement vs the Peak Eosinophilic Count (PEC). Methods: A retrospective chart review was performed for patients during 2014–2016. All patients ≤18 years old with a diagnosis of EoE and whose records included initial and follow-up upper gastrointestinal endoscopies were included. Severity and extent of endoscopic features were scored using 8 parameters, from normal to maximum change for each location of the esophageal biopsy. Results: Forty patients with EoE were included in the study, of which 35 (87.5%) patients demonstrated symptom and 25 (62.5%) endoscopic improvement at the time of follow-up. In the proximal esophagus, the EoE HSS outperformed the change in eosinophil count of the Children’s Hospital of Eastern Ontario (CHEO) practice in predicting endoscopic improvement by 16.8% when examining the change in grade and 17.1% when examining the change in stage scores. Conclusions: At our institution, adoption of the EoE HSS in assessing biopsies of EoE patients might be warranted, compared to the traditional practice. However, a bigger sample size may give a more robust difference in all locations.

A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions

“…82 The EoEHSS has also been shown to be responsive to treatment and provide a more complete picture of overall histologic severity. 83,84 BZH, a feature evaluated in the EoEHSS, may persist in children and adult EoE patients who have persistent symptoms but fewer than 15 eosinophils per high-power field (eos/hpf) in esophageal biopsies. 38,85 Both BZH and lamina propria fibrosis (LPF), another feature evaluated in the EoEHSS, may contribute to long-term remodeling of esophageal biopsies in children who have EoE.…”

The Dual Lens of Endoscopy and Histology in the Diagnosis and Management of Eosinophilic Gastrointestinal Disorders—A Comprehensive Review

“…When comparing EoEHSS with PEC, Ma et al found similar outcomes in correlating histological EoE activity (AUC of 0.73 in both methods) [116]. In pediatric studies, EoEHSS has been found to be superior to PEC in predicting endoscopic remission [117]. Alexander and colleagues suggested that an EoEHSS score ≤3 correlates with endoscopic and histologic disease remission, but not with symptoms [118].…”