Pathological identification of esophageal eosinophilia (EE) is considered to be most important and critical step for diagnosis of eosinophilic esophagitis (EoE). Although several endoscopic findings related with EoE have been reported, it is still difficult to exclude other causes of EE, such as gastroesophageal reflux disease. Here, we noted a novel endoscopic finding related with EoE termed ‘Caterpillar sign’. The aim of this study was to evaluate its clinical significance for the diagnosis of EoE. Methods One hundred and seventy-four patients who were endoscopically suspected with EoE at our hospital and affiliated institutions were enrolled. EoE was defined clinically by symptoms of esophageal dysfunction and histologically by the presence of EE [≧15 eosinophils/high power field (HPF)]. Endoscopic findings at baseline were retrospectively reviewed. ‘Caterpillar sign’ was defined as a stair-like, fragile, slight mucosal protruded lesion sandwiched between longitudinal furrows, such as the Caterpillar traces remaining on the ground (Figure). Furthermore, the clinicopathological features of patients having ‘Caterpillar sign’ were evaluated. Results One hundred and seventy-four patients (92 males, 82 females with mean age of 49.7) suspected with EoE were evaluated, of whom 60 (34.5%) was finally diagnosed as EoE. ‘Caterpillar sign’ was found in 48 patients (80.0%). Sensitivity and Specificity of ‘Caterpillar sign’ for the diagnosis of EoE was 0.80 (95% confidence interval [CI] 0.72–0.85) and 0.94 (95% CI 0.90–0.97), respectively. Furthermore, the presence of ‘Caterpillar sign’ was associated with degree of eosinophil infiltration (Caterpillar sign positive: 42.9 ± 49.3/HPF vs. Caterpillar sign negative: 6.7 ± 24.4/HPF, p < 0.0001). Conclusion This novel finding termed ‘Caterpillar sign’ was clinically useful for the definitive diagnosis of EoE and associated with degree of eosinophil infiltration.

中文翻译：

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173 毛虫体征：嗜酸性食管炎患者的新内镜检查结果

食管嗜酸性粒细胞增多症（EE）的病理鉴定被认为是诊断嗜酸性粒细胞性食管炎（EoE）最重要和最关键的步骤。尽管已经报道了一些与 EoE 相关的内镜检查结果，但仍然难以排除 EE 的其他原因，例如胃食管反流病。在这里，我们注意到与 EoE 相关的一种新的内窥镜发现，称为“毛毛虫征”。本研究的目的是评估其对 EoE 诊断的临床意义。方法 纳入我院及附属机构内镜下疑似EoE患者174例。EoE 在临床上由食管功能障碍的症状定义，在组织学上由 EE [≥15 个嗜酸性粒细胞/高倍视野 (HPF)] 的存在定义。回顾性回顾了基线的内窥镜检查结果。“毛毛虫征”被定义为夹在纵向沟之间的阶梯状、易碎、轻微黏膜突出病变，例如残留在地面上的毛毛虫痕迹（图）。此外，评估了具有“毛毛虫征”的患者的临床病理学特征。结果 对疑似 EoE 的 174 例患者（男 92 例，女 82 例，平均年龄 49.7 岁）进行了评估，最终诊断为 EoE 患者 60 例（34.5%）。在 48 名患者 (80.0%) 中发现了“毛毛虫征”。“毛虫征”对 EoE 诊断的敏感性和特异性分别为 0.80（95% 置信区间 [CI] 0.72–0.85）和 0.94（95% CI 0.90–0.97）。此外，“Caterpillar 征”的存在与嗜酸性粒细胞浸润程度相关（Caterpillar 征阳性：42.9 ± 49.3/HPF 与 Caterpillar 征阴性：6.7 ± 24.4/HPF，p < 0.0001）。结论 这一被称为“毛毛虫征”的新发现在临床上可用于明确诊断 EoE，并与嗜酸性粒细胞浸润程度相关。