Aims
The primary objective of this study is to assess, at the time of the initial diagnostic upper gastrointestinal endoscopy, the correlation between endoscopic features suggestive of eosinophilic esophagitis and their subsequent histopathological confirmation.
Methods
A retrospective observational study was conducted on upper gastrointestinal endoscopies performed at our center between 2008 and 2024, in which the diagnostic report included “eosinophilic esophagitis.” Only procedures in which the endoscopist obtained esophageal biopsies to rule out this disease—regardless of whether endoscopic findings suggestive of eosinophilic esophagitis were present—were included.
The indication for endoscopy, the medical specialty requesting the procedure, and the analytical data available prior to endoscopy were analyzed. In addition, the pharmacological treatments patients were receiving at the time of the procedure were recorded, and the histological results of the esophageal biopsy samples were reviewed.
Results
A total of 201 patients were analyzed. Of the total sample (n = 201), 74 patients were ultimately diagnosed with eosinophilic esophagitis (EoE) based on histological findings (36.82%), whereas 127 patients (63.18%) were not.
The mean age in the male group was 39 years (median: 42 years), while in the female group it was 49 years (median: 48 years).
Of the total sample (n = 201), 74 patients were ultimately diagnosed with eosinophilic esophagitis (EoE) based on histological findings (36.82%), whereas 127 patients (63.18%) were not.
Personal and medical histories were analyzed, revealing a higher proportion of males in the group diagnosed with EoE. In addition, a higher incidence of food allergies, dust/mite allergies, and asthma was observed among patients with confirmed EoE.
|
Variables Analyzed |
Eosinophilic Esophagitis Diagnosedn = 74 (36.82%) |
Eosinophilic Esophagitis Not Diagnosedn = 127 (63.18%) |
|---|---|---|
|
Gender |
||
|
Male |
52 (70.3%) |
61 (48%) |
|
Female |
22 (29.7%) |
66 (52%) |
|
Food Allergies |
||
|
Yes |
11 (14.9%) |
6 (4.7%) |
|
No |
63 (85.1%) |
121 (95.3%) |
|
Symptoms |
||
|
Dyspepsia/GERD |
15 (20.3%) |
36 (28.3%) |
|
Dysphagia |
54 (73%) |
83 (65.4%) |
|
Foreign body sensation |
5 (6.8%) |
8 (6.3%) |
Conclusions
The reason for endoscopy referral appears to influence the thoroughness of esophageal evaluation. In cases where the indication was dysphagia or a request to rule out EoE, a stronger correlation was observed between endoscopic findings and histological confirmation.
The presence of longitudinal furrows and esophageal rings are common endoscopic features associated with EoE diagnosis. In patients presenting with more than one typical endoscopic finding (exudates, longitudinal furrows, or rings), the likelihood of EoE increases progressively with each additional finding, particularly when both rings and longitudinal furrows coexist. The presence of exudates and mucosal edema, however, is not commonly reported.
Peripheral blood eosinophilia was a frequent finding among patients diagnosed with EoE, and the use of single-dose proton pump inhibitors (PPIs) did not appear to influence its occurrence. Furthermore, PPI use at standard doses in patients with EoE did not seem to obscure the presence of certain endoscopic features, such as rings and longitudinal furrows.
In patients without endoscopic abnormalities suggestive of EoE, if clinical suspicion is low, esophageal biopsy may not be necessary—even in the presence of dysphagia.
Endoscopist experience did not appear to have a significant impact on diagnostic accuracy.