Eosinophilic Esophagitis: Relationship of Subepithelial Eosinophilic Inflammation With Epithelial Histology, Endoscopy, Blood Eosinophils, and Symptoms.

Schoepfer, Alain M; Simko, Audrey; Bussmann, Christian; Safroneeva, Ekaterina; Zwahlen, Marcel; Greuter, Thomas; Biedermann, Luc; Vavricka, Stephan; Godat, Sébastien; Reinhard, Antoine; Saner, Catherine; Maye, Hugo; Sempoux, Christine; Brunel, Christophe; Blanchard, Carine; Simon, Dagmar; Simon, Hans-Uwe; Straumann, Alex (2018). Eosinophilic Esophagitis: Relationship of Subepithelial Eosinophilic Inflammation With Epithelial Histology, Endoscopy, Blood Eosinophils, and Symptoms. American journal of gastroenterology, 113(3), pp. 348-357. Nature 10.1038/ajg.2017.493

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OBJECTIVES For technical reasons, the histologic characterization of eosinophilic esophagitis (EoE)-specific alterations is almost exclusively based on those found in the esophageal epithelium, whereas little is known about subepithelial abnormalities. In this study, we aimed to systematically assess the nature of subepithelial histologic alterations, and analyze their relationship with epithelial histologic findings, endoscopic features, and symptoms. METHODS Adult patients with established EoE diagnosis were prospectively included during a yearly follow-up visit. Patients underwent assessment of clinical, endoscopic, and histologic disease activity using EoE-specific scores. RESULTS We included 200 EoE patients (mean age 43.5±15.7 years, 74% males) with a median peak count of 36 intraepithelial eosinophils/hpf (IQR 14-84). The following histologic features were identified in the subepithelial layer: eosinophilic infiltration (median peak count of 20 eosinophils/hpf (IQR 10-51)), eosinophil degranulation (43%), fibrosis (82%), and lymphoid follicles (56%). Peak intraepithelial eosinophil counts were higher, identical, and lower when compared to the subepithelial layer in 62.5%, 7%, and 30.5% of patients, respectively. Anti-eosinophilic treatment at inclusion did not influence the relation between subepithelial and epithelial peak eosinophil counts. Subepithelial histologic activity correlated with epithelial histologic activity (rho 0.331, P<0.001), endoscopic severity (rho 0.208, P=0.003), and symptom severity (rho 0.179, P=0.011). Forty percent (21/52) of patients with <15 intraepithelial eosinophils/hpf had subepithelial peak counts of ≥15/hpf. CONCLUSIONS There is a significant but modest correlation between subepithelial histologic activity and epithelial histologic activity, endoscopic severity, and symptom severity. The long-term clinical impact of assessing subepithelial alterations in EoE needs to be further elucidated.Am J Gastroenterol advance online publication, 16 January 2018; doi:10.1038/ajg.2017.493.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Dermatology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Pharmacology

UniBE Contributor:

Safroneeva, Ekaterina; Zwahlen, Marcel; Simon, Dagmar and Simon, Hans-Uwe

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0002-9270

Publisher:

Nature

Language:

English

Submitter:

Sandra Nyffenegger

Date Deposited:

15 Feb 2018 10:27

Last Modified:

14 Dec 2018 12:24

Publisher DOI:

10.1038/ajg.2017.493

PubMed ID:

29336433

BORIS DOI:

10.7892/boris.110552

URI:

https://boris.unibe.ch/id/eprint/110552

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