Introduction Eosinophilic Oesophagitis (EoE) is an increasing clinical problem. Patients with EoE commonly present with dysphagia, food impaction, chest pain unresponsive to antacids, and gastro-oesophageal reflux disease (GORD) like symptoms. To confirm a diagnosis of EoE, it is highly recommended to obtain oesophageal biopsies following trial of high-dose proton pump inhibitor therapy (to exclude GORD which may also have microscopic eosinophilia). Sampling from both normal and abnormal appearing areas with a minimum of 4 biopsies (each proximal and distal oesophagus) is recommended. Doing 6–9 biopsies increases the sensitivity of detecting EoE to 100%. Histologically, the diagnosis of EoE is made in presence of at least 15 eosinophils per high-power field (hpf) and should be documented in the microscopic histopathology report.
Method A single centre, retrospective analysis, of patients with a diagnosis of EoE at a large NHS Hospital Trust in north London over 4 years from 2010 was performed. The database of patients was obtained from histology department. The endoscopy and histology report of the patients were analysed for the number of biopsies obtained (protocol recommends 8), site at which biopsies were obtained (protocol recommends proximal and distal oesophagus) and presence of > 15 eosinophils per hpf within the histology report.
Results During the study period, 29 patients with EoE were identified. The number of biopsies obtained varied from 1–8 (mean 3.5). One patient had 8 biopsies. 28/29 patients had 7 or less biopsies obtained. No patient had at least 4 biopsies from 2 different sites, with 15 (52%) having biopsy from lower oesophagus, 10 (30%) from mid oesophagus, 2 (7%) from middle and upper oesophagus and 1 (3%) from upper and lower oesophagus, One had biopsies fromupper, middle and lower oesophagus. In 6 of 29 (20%),the histopathology report explicitly mentioned the presence of >15 eosinophils per hpf.
Conclusion From this study, we conclude that biopsy protocol for diagnosis of EoE falls short of the consensus recommendations, not only in the total number of oesophageal biopsies obtained but also location from which biopsies are obtained. In only 83% of patients was the recommended diagnostic criteria of >15 eosinophils per hpf used. If biopsy and reporting protocol is not followed there is a risk that patients with another cause of raised eosinophils (eg GORD) may be incorrectly diagnosed with EoE. We recommend a greater awareness and observation of the protocol for obtaining biopsies and its histology reporting in EoE.
Disclosure of interest None Declared.
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