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.
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.
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.
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.
1Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
2Institute of Pathology, Viollier AG, Basel, Switzerland
3Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
4Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
5Division of Gastroenterology and Hepatology, Triemlispital, Zurich, Switzerland
6Division of Otorhinolaryngology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
7Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
8Division of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
9Institute of Pathology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
10Nestlé Research Center, Lausanne, Switzerland
11Division of Dermatology and Allergy, Inselspital/University Hospital Bern, Bern, Switzerland
12Institute of Pharmacology, University of Bern, Bern, Switzerland
13Swiss EoE Clinic, Praxis Römerhof, Olten, Switzerland
Correspondence: Alain M. Schoepfer, MD, PD+MERClin, Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 44/07/2409, CH-1011, Lausanne, Switzerland. E-mail: email@example.com
14These authors contributed equally to this work.
published online 16 January 2018
SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A293, http://links.lww.com/AJG/A294
Received 21 May 2017; accepted 12 November 2017