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Endoscopic Classification of Esophagic Eosinophilia
Augusto Fey, Lorete Maria da Silva Kotze and Mônica Serapião
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DOI:10.17265/2328-2150/2018.06.008
Introduction: EoE (eosinophilic esophagitis) is an inflammatory
condition characterized by a dense eosinophilic infiltrate in the esophageal
epithelium. In Brazil, it remains a poorly diagnosed disease due to the lack of
interaction between the clinician, the endoscopist, and the pathologist. The
diagnosis is performed by histological study of esophageal biopsies, with at
least fifteen eosinophils per high-power field (EOS/HPF). Some doubts remain with
respect to patients with a clinical picture and symptoms compatible with the
disease (EoE), but who have a lower number of eosinophils than established. The
main objective of this study was to create an endoscopic classification for EsEo
(esophageal eosinophilia), which pointed the way to the endoscopist towards the
diagnosis. Methods: This study was a prospective, two-year study, at
a gastrointestinal endoscopy center where all patients with endoscopic symptoms
and/or endoscopic findings suggestive of EsEo were biopsied for histological
examination of EOS/HPF. After the study and
compilation of the results, a retrospective study was performed, based on a
review of electronic medical records, where the same diagnosis was searched,
although at a period when this classification was not adopted. Results: A total of 4,251 endoscopies were
performed between September 2011 and September 2013. Two biopsies were
performed, aimed at lesions, in 133 patients with clinical picture or imaging
suggestive of EsEo. Eosinophils were found in 55 patients, corresponding to
an incidence of 1.29% of the total population studied and 41.35% of the
suspected cases of the disease. EoE was diagnosed in 24 patients during the period of this study. In the
two-year retrospective study, only two cases of EoE were found. Conclusions: The results of this
study demonstrate that the endoscopic standardization of esophageal lesions,
suggestive of eosinophilia, in this case by classification, alerts the
endoscopist for the diagnosis of EoE, prompting him to perform targeted
biopsies. Further, it was observed that two samples of esophageal tissue were
sufficient for the diagnosis. The relationship between the clinical picture,
endoscopy, and histology was not evident in this study.
Endoscopic classification, eosinophilic esophagitis, esophageal eosinophilia, esophagus, eosinophils.
Fey, A., et al. 2018. “Endoscopic Classification of Esophagic Eosinophilia.” Journal of Pharmacy and Pharmacology 6 (6): 604-612.