Background and Aims

Subepithelial fibrosis in eosinophilic esophagitis (EoE) can be detected only in esophageal biopsy specimens with adequate amounts of lamina propria (LP). We investigated how often pediatric esophageal biopsy specimens contain adequate LP, and whether esophageal eosinophilia influences the acquisition rates.

Methods

We evaluated 284 esophageal biopsy specimens from 39 patients with EoE, and 87 biopsy specimens from 32 patients without esophageal eosinophilia or other esophageal abnormalities for the presence of adequate LP and fibrosis.

Results

On a per biopsy specimen basis, there was no significant difference in the rate of procuring adequate amounts of LP between patients with EoE and patients without esophageal eosinophilia (43% vs 31%, P = .14). Eighty-five percent of patients with EoE had fibrosis. Fibrosis in patients with EoE was patchy and more likely to be detected in the middle or distal esophagus (odds ratio, 19.93; 95% confidence interval, 4.12-91.52). Among patients with fibrosis, the probability of its detection reached >95% with 7 middle-distal esophageal biopsy specimens. Most children with newly diagnosed EoE already had subepithelial fibrosis despite exhibiting only inflammatory endoscopic features.

Conclusions

Most individual esophageal biopsy specimens in children are inadequate for assessing subepithelial fibrosis, and the rates of procuring adequate LP per biopsy specimen are similar in patients with and without EoE. To reliably detect fibrosis in patients with EoE, at least 7 biopsy specimens should be taken from the middle-distal esophagus. The finding of fibrosis in children with newly diagnosed EoE and only inflammatory endoscopic features suggests that fibrosis can occur early in this disease.

中文翻译：

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在儿童嗜酸性粒细胞性食管炎中获得足够的固有层用于上皮下纤维化评估

背景和目标

嗜酸性食管炎（EoE）中的上皮下纤维化只能在食管活检标本中含有足够数量的固有层（LP）的情况下才能检测到。我们调查了小儿食管活检标本多长时间含有足够的LP，以及食管嗜酸粒细胞增多是否会影响采集率。

方法

我们评估了39例EoE患者的284例食管活检标本，以及32例没有食管嗜酸粒细胞增多或其他食管异常的患者的87例活检标本，以了解是否存在足够的LP和纤维化。

结果

在每个活检标本的基础上，有EoE的患者和没有食管嗜酸性粒细胞的患者之间获得足够量LP的比率没有显着差异（43％vs 31％，P  = 0.14）。EoE患者中有百分之八十五患有纤维化。EoE患者的纤维化是不规则的，在食道中部或远端的可能性更高（优势比为19.93； 95％置信区间为4.12-91.52）。在有纤维化的患者中，使用7例中远端食管活检标本检测到纤维化的可能性达到了95％以上。尽管仅表现出炎症性内窥镜特征，大多数新诊断为EoE的儿童已经患有上皮下纤维化。

结论

儿童中大多数个体食管活检标本不足以评估上皮下纤维化，在有和没有EoE的患者中，每份活检标本获得足够LP的比率相似。为了可靠地检测EoE患者的纤维化，应从中远端食管中至少采集7个活检标本。在新诊断为EoE且仅具有炎症性内窥镜特征的儿童中发现纤维化表明，纤维化可以在这种疾病的早期发生。