1. ¹Department of Pathology, London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
2. ²Department of Medicine, London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada

Correspondence: Dr DK Driman, MBChB, FRCPC, Department of Pathology, London Health Sciences Centre and University of Western Ontario, 339 Windermere Road, London, Ontario, Canada N6A 5A5. E-mail: ddriman@uwo.ca

Received 14 June 2005; Revised 18 August 2005; Accepted 26 August 2005; Published online 7 October 2005.

Abstract

Eosinophilic esophagitis in adults is a recently described entity occurring in young males with dysphagia, in whom esophageal biopsies show eosinophilic infiltration. This study defines the clinical and histological features of patients with eosinophilic esophagitis, distinguishing it from gastroesophageal reflux disease. Esophageal biopsies from patients with dysphagia or esophagitis were reviewed blindly, and assessed for: epithelial eosinophil counts, presence of eosinophilic microabscesses, edema, basal zone hyperplasia, lamina propria papillae elongation, eosinophils and fibrosis. Clinical and endoscopic findings were obtained. Eosinophilic esophagitis was diagnosed with epithelial eosinophils 15 in 2 high-power fields (hpfs) or 25 in any hpf. Analysis was performed with Mann–Whitney, ² and ANOVA tests. Of 157 cases, 41 had eosinophilic esophagitis. Male gender (81%) and age 45 (54%) were commoner in patients with eosinophilic esophagitis (P=0.001, 0.010, respectively). Dysphagia was more common in eosinophilic esophagitis patients (63%, P<0.001); heartburn was more common in noneosinophilic esophagitis patients (53%, P<0.001). Endoscopic rings were more common in eosinophilic esophagitis patients (27%, P=0.023); hiatus hernia was more common in noneosinophilic esophagitis patients (11%, P=0.022). Eosinophils were more numerous in eosinophilic esophagitis biopsies (mean 39/hpf, P0.001). Only eosinophilic esophagitis biopsies had eosinophilic microabscesses (42%, P0.001). Edema, basal zone hyperplasia, lamina propria papillae elongation and lamina propria eosinophils were commoner in eosinophilic esophagitis (P=<0.001–0.002), while lamina propria fibrosis was specific for eosinophilic esophagitis (39%, P<0.001). Eosinophilic esophagitis is a disease with a predilection for young males with dysphagia and rings on endoscopy. Biopsies in eosinophilic esophagitis have high epithelial eosinophil counts, averaging nearly 40/hpf. Increased awareness of eosinophilic esophagitis is necessary, since treatment with allergen elimination or anti-inflammatory therapy may be more effective than acid suppression.