University of Utah School of Medicine Salt Lake City, UT, United States
Kathryn Peterson, MD, MSCI1, Robert M. Genta, MD, FACG2, Henrik Rasmussen, MD, PhD3, Bradford A. Youngblood, PhD3, Amol P. Kamboj, MD3 1University of Utah School of Medicine, Salt Lake City, UT; 2Inform Diagnostics, Irving, TX; 3Allakos, Inc., Redwood City, CA
Introduction: Many patients with eosinophilic esophagitis (EoE) present with extra-esophageal or atypical symptoms. We previously evaluated gastric and duodenal biopsies from patients with EoE with and without persistent extra-esophageal gastrointestinal (GI) symptoms to determine if they had eosinophilic gastritis and/or duodenitis (EG and/or EoD)1. In this study, we investigated correlations between peak esophageal eosinophil counts and concomitant EG and/or EoD.
Methods: We studied 45 patients with EoE and GI symptoms (abdominal pain, nausea, bloating) and/or a previous diagnosis of irritable bowel syndrome (EoE+S) and 12 patients with EoE without extra-esophageal symptoms (EoE–S). All had initial gastric and duodenal biopsies interpreted as non-specific inflammation or normal. Gastric and duodenal eosinophils were systematically counted in biopsies by a blinded GI pathologist; EG and EoD were defined as ≥30 eosinophils/high-power field (hpf) in ≥5 hpfs in gastric and ≥3 hpfs in duodenal specimens, respectively.
Results: Thirty-one of the 45 EoE+S patients (69%) met histologic criteria for EG and/or EoD: 8 (18%) met histologic criteria for EG and 23 (51%) met histologic criteria for EoD. None of the EoE–S patients met histologic criteria for EG and 3 met histologic criteria for EoD. Peak esophageal eosinophil counts did not differ significantly between patients with EoE+S vs EoE–S, and were not associated with the presence of EG or EoD (Figure).
Discussion: Sixty-nine percent of patients with EoE and extra-esophageal GI symptoms met the histologic criteria for EG and/or EoD. Peak esophageal eosinophil counts were not associated with the presence of EG or EoD and therefore should not be used to guide gastroduodenal biopsy. Patients with EoE and persistent extra-esophageal GI symptoms, regardless of peak esophageal eosinophil counts, should undergo systematic collection and histologic analysis of gastric and duodenal biopsies to identify those with concomitant EG and/or EoD.
Reference: 1. Peterson KA, Genta RM, Rasmussen HS, et al. Fr178: Gastroduodenal Eosinophilia Is Under-Appreciated in Eosinophilic Esophagitis (EoE) Patients With Functional Bowel Symptoms: A Real Life Experience.Gastroenterology.2021 May;160(6): Supplement:S262.
Figure: Figure: Peak Esophageal Eosinophil Counts in Patients With EoE, With vs Without GI Symptoms EoE+S EG: patients with EoE and extra-esophageal GI symptoms who met criteria for EG (≥30 eos in ≥5 gastric hpfs) EoE+S EoD: patients with EoE and extra-esophageal GI symptoms who met criteria for EoD (≥30 eos in ≥3 duodenal hpf) EoE–S: patients with EoE without extra-esophageal GI symptoms Dotted line indicates histologic threshold for EG and/or EoD Caps indicate minimum and maximum; box, 25th and 75th percentile; center line, median P value from unpaired t test of simple 1-way ANOVA, compared with EoE-S Note: Some patients were receiving treatment for EoE at the time of esophageal biopsy collection
Kathryn Peterson, MD, MSCI1, Robert M. Genta, MD, FACG2, Henrik Rasmussen, MD, PhD3, Bradford A. Youngblood, PhD3, Amol P. Kamboj, MD3. P0306 - Patients With Eosinophilic Esophagitis and Gastrointestinal Symptoms May Have Eosinophilic Gastritis and/or Duodenitis, Not Associated With Peak Esophageal Eosinophil Count, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.