Diagnostic Criteria for Eosinophilic Esophagitis: A 5-year Retrospective Review in a Pediatric Population

Background: The diagnostic criterion based on the number of eosinophils (Eos) per high-power field (HPF) does not appear to capture all patients with eosinophilic esophagitis (EE). Objectives: To determine whether EE has been underrecognized at our institution, clinical variables predicting EE, and whether the Luna eosinophil granule (LEG) stain detects eosinophils better than hematoxylin and eosin (HE). Materials and Methods: Esophageal biopsies of 202 children younger than 19 years old from 2000 to 2004 were reviewed and Eos/HPF was recorded. Clinical variables from charts were reviewed and a marginal logit model was used to determine significance. LEG stains for 60 randomly selected patients were prepared and compared to HE originals. Results: EE diagnoses have risen from none in 2000 to 23 in 2004. The clinically significant variables that predicted EE were improvement from EE treatment (160 times more likely to have EE; P < 0.0005), final endoscopic diagnosis of EE (31 times; P=0.004), absence of vascular pattern on endoscopy (20 times; P=0.008), and vertical furrows on endoscopy (29 times; P=0.039). LEG stain appeared to be superior to HE in detecting low Eos/HPF (mean 24.82 and 38.53, respectively). Peak counts of eosinophils in the most involved HPF significantly correlated with highest average count of eosinophils per HPF in the most involved specimen (Pearson correlation 0.958). Conclusions: Misdiagnosed EE cases decreased but prevalence appeared to increase. LEG potentially can be a more sensitive stain. The key variables that predict EE were typical endoscopic findings and improvement from specific EE treatment. JPGN 49:6.7-70, 2009.