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Eosinophils in the oesophageal mucosa: clinical, pathological and epidemiological relevance in children: a cohort study
  1. Marta C Cohen1,
  2. Prithviraj Rao2,
  3. Mike Thomson2,
  4. Mudher Al-Adnani1
  1. 1Department of Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
  2. 2Department of Paediatrics, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Marta C Cohen; marta.cohen{at}sch.nhs.uk

Abstract

Objectives Eosinophilic oesophagitis (EO) shows eosinophilic infiltration of the mucosa and can present with symptoms indistinguishable from gastrooesophageal reflux disease (GORD). The authors describe the clinical, endoscopic and histopathological features of all cases of histological EO presenting during 2007–2008 with a 2-year follow-up. The incidence of paediatric EO and the features of a subgroup with features of both GORD and EO (‘overlap’ syndrome (OS)) are described.

Design Biopsies with an average of 15 eosinophils/high-power field (HPF) were reviewed in the cohort. OS was suggested when there was coexistence of clinical and histological features of EO and GORD (abnormal pH study), which improved with proton pump inhibitors.

Setting Tertiary care.

Participants All cases with ≥15 eosinophils/HPF entered the study.

Primary outcome measures Patients with EO had an average of 15 eosinophils/HPF.

Secondary outcome measures Other histological features of EO included microabscesses, dilated intercellular spaces, basal cell hyperplasia, papillary elongation, etc.

Results 24 cases of EO were identified, 13 men and 11 women. The incidence of paediatric oesophageal eosinophilia in the region was 9/100 000 children. 11 of the 24 patients (46%) presented with some form of allergy, six with poor feeding/food aversion, five with dysphagia and four with vomiting. After follow-up, 56.5% were confirmed to have EO, 30.5% responded to treatment for GORD and were categorised as OS, 9% developed eosinophilic gastroenteritis and 4% did not have further upper gastrointestinal symptoms.

Conclusions Accurate diagnosis of EO, especially the differentiation from GORD, requires appropriate clinicopathological correlation. A significant proportion of patients with eosinophilia in the mucosa also have GORD (OS). These patients improve after treating the underlying GORD. The study was registered as a Service Evaluation with the Trust (number SE74).

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Footnotes

  • To cite: Cohen MC, Rao P, Thomson M, et al. Eosinophils in the oesophageal mucosa: clinical, pathological and epidemiological relevance in children: a cohort study. BMJ Open 2012;2:e000493. doi:10.1136/bmjopen-2011-000493

  • Funding This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Clinical Governance Group.

  • Contributors MCC designed the study, acquired the histological data, analysed the histology and was the main author in the task of writing and approving the final version of the study. PR designed and acquired the clinical and endoscopic data, critically reviewed and improved the article and approved the final version to be published. MT designed and acquired the clinical and endoscopic data, critically reviewed and improved the article and approved the final version to be published. MA-A analysed the histology, contributed to writing the initial draft, critically reviewed the article and approved the final version to be published.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Technical appendix and data set available from the corresponding author (marta.cohen{at}sch.nhs.uk). Consent was not specifically obtained as this was a retrospective study, but the presented data are anonymised, and risk of identification is low.

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