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Low Grade Esophageal Eosinophilia in Adults: An Unrecognized Part of the Spectrum of Eosinophilic Esophagitis?

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Abstract

Background

Eosinophilic esophagitis (EoE) is defined by a minimum of 15 eosinophils (eos) per high-powered field (HPF) on esophageal biopsy, along with esophageal symptoms and the exclusion of gastroesophageal reflux (GERD). The clinical significance of fewer eosinophils is unknown.

Methods

Fifty-nine adult patients without a previous diagnosis of EoE with esophageal biopsies containing 1–14 eos per HPF (low grade eosinophilia) and 418 adult patients with ≥15 eos per HPF were identified by retrospective review. Patients were divided into group A (1–9 eos per HPF), group B (10–14 eos per HPF), and group C (≥15 eos per HPF) with a chart review of clinical and demographic data.

Results

While dysphagia and atopy (asthma and allergic rhinitis) were more common in patients with ≥15 eos per HPF (group C) than those with low grade esophageal eosinophilia (groups A and B) (93 vs. 88%, P = 0.02), food impaction and heartburn occurred at an equal frequency across all patient groups. Endoscopic findings were likewise similar between groups. Of the 14 patients with low grade esophageal eosinophilia who underwent repeat endoscopy a mean interval of 42 weeks (range 8–118 weeks) later, five (36%) met conventional diagnostic criteria for EoE of 15 or greater eos per HPF. Follow-up in ten patients treated with topical corticosteroids noted improvement in nine, with mean follow-up of 8 weeks (range 4–12 weeks).

Conclusion

Some adult patients with dysphagia and less than 15 eos per HPF have similar endoscopic findings and clinical course to patients meeting the consensus definition of EoE. Further evaluation of patients with low grade esophageal eosinophilia is needed.

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Conflicts of interest

None of the authors have conflicts of interests to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology & Hepatology, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA

    Karthik Ravi, David A. Katzka, Lori Kryzer, Yvonne Romero, Amindra S. Arora & Jeffrey A. Alexander

  2. Division of Gastroenterology and Hepatology, University of Newcastle, Newcastle, NSW, Australia

    Nicholas J. Talley

  3. Division of Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Thomas C. Smyrk

Authors
  1. Karthik Ravi
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  2. Nicholas J. Talley
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  3. Thomas C. Smyrk
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  4. David A. Katzka
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  5. Lori Kryzer
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  6. Yvonne Romero
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  7. Amindra S. Arora
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  8. Jeffrey A. Alexander
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Correspondence to Jeffrey A. Alexander.

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Ravi, K., Talley, N.J., Smyrk, T.C. et al. Low Grade Esophageal Eosinophilia in Adults: An Unrecognized Part of the Spectrum of Eosinophilic Esophagitis?. Dig Dis Sci 56, 1981–1986 (2011). https://doi.org/10.1007/s10620-011-1594-1

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  • DOI: https://doi.org/10.1007/s10620-011-1594-1

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