Persistent Basal Cell Hyperplasia is Associated with Clinical and Endoscopic Findings in Patients With Histologically Inactive Eosinophilic Esophagitis

• Published in: Clinical gastroenterology and hepatology Vol. 18; no. 7; pp. 1475 - 1482.e1
• Main Authors: Whelan, Kelly A, Godwin, Bridget C, Wilkins, Benjamin, Elci, Okan U, Benitez, Alain, DeMarshall, Maureen, Sharma, Medha, Gross, Jonathan, Klein-Szanto, Andres J, Liacouras, Chris A, Dellon, Evan S, Spergel, Jonathan M, Falk, Gary W, Muir, Amanda B, Nakagawa, Hiroshi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2020
• Subjects: Adolescent; Eosinophilic Esophagitis - pathology; Eosinophils - pathology; Epithelium; Esophagus; Gastroenterology and Hepatology; Humans; Hyperplasia - pathology; Inflammation; Leukocyte Count; Outcome; Prognostic Factor; eosinophils per high-powered field; University of Carolina; IHC; PPI; esophagogastroduodenoscopy; UNC; gastro-esophageal reflux disease; proton pump inhibitor; Hematoxylin and Eosin; Children’s Hospital of Philadelphia; basal cell hyperplasia; inflammation; CHOP; MBP; Eos/hpf; immunohistochemistry; outcome; GI; HUP; EGD; prognostic factor; BCH; H&E; DIS; gastrointestinal; GERD; major basic protein; Hospital of the University of Pennsylvania; eosinophilic esophagitis; epithelium; dilated intercellular spaces; EoE; esophagus; OR; CI; Inflammation; Epithelium; Esophagus; eos/hpf; Outcome; Prognostic Factor
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2019.08.055

AbstractBackground & AimsAlthough eosinophil count is the standard used to monitor disease activity in patients with eosinophilic esophagitis (EoE), there are often disparities between patient-reported symptoms and eosinophil counts. We examined the prevalence of epithelial alterations, namely basal cell hyperplasia (BCH) and spongiosis, among patients with inactive EoE (eosinophil counts below 15 following therapy) and aimed to determine whether maintenance of these changes in epithelial morphology are associated with persistent clinical findings. MethodsEsophageal biopsies of 243 patients (mean age, 16.9 years) undergoing routine endoscopy at the University of Pennsylvania were evaluated for epithelial BCH and spongiosis. Univariable analysis was used to calculate the association between epithelial changes and symptoms as well as endoscopic findings and peak eosinophil count. We validated our findings using data from a cohort of patients at the University of North Carolina. ResultsThe discovery and validation cohorts each included patients with inactive EoE, based on histologic factors, but ongoing BCH and spongiosis. Ongoing BCH, but not spongiosis, in patients with inactive EoE was associated with symptoms (odds ratio, 2.14; 95% CI, 1.03–4.42; P=.041) and endoscopic findings (odds ratio, 7.10; 95% CI, 3.12–16.18; P<.001). ConclusionsIn patients with EoE, the presence of BCH might indicate ongoing disease activity, independent of eosinophil count. This might account for the persistent symptoms in patients who are considered to be in remission based on histologic factors.