Photo Credit: Md Ariful Islam

The following is a summary of “Yield of Esophageal Biopsy Patterns for the Diagnosis of Eosinophilic Esophagitis,” published in the January 2025 issue of Gastroenterology by Mufath et al.

Eosinophilic esophagitis (EoE) features patchy inflammation, requiring multiple biopsies for accurate diagnosis. Current guidelines recommend six biopsies from two esophageal sites, but their effectiveness remains unclear.

Researchers conducted a retrospective study to evaluate the effectiveness of current biopsy protocols for diagnosing EoE.

They reviewed the demographics, clinical characteristics, endoscopic findings, and histologic results of consecutive, newly diagnosed patients with EoE and ≥2 esophageal segments biopsied. They assessed the distribution of eosinophilia (>15 eosinophils/hpf) in the proximal, middle, and distal segments. Multivariable logistic regression was used to evaluate predictors for non-distal disease (<15 eosinophils/hpf on distal biopsies).

The results showed that 511 newly diagnosed patients with EoE and ≥2 segments biopsied were included. Of these, 286 (56.0%) had ≥1 site with <15 eosinophils/hpf, including 51 (10%) with non-distal disease. Among 60 patients with 3 segments biopsied, 19 (31.7%) had eosinophilia at 1 site, including 6 (10%) with isolated mid esophageal disease. Discordant biopsy results were found in 18 (30%) patients, with 17/18 (94.4%) showing mid esophageal eosinophilia. Multivariable analysis showed that increasing age (OR:1.02, CI:1.002–1.04, P=0.03) and male gender (OR:1.89, CI:1.002–3.55, P=0.049) independently predicted non-distal disease.

Investigators found isolated segmental eosinophilia, including non-distal disease in 10% of cases, was common. They recommended routine biopsies of both distal and middle esophagus for better diagnosis.

Source: sciencedirect.com/science/article/abs/pii/S0016510725000434