Abstract:

Background and Aims:Eosinophilic esophagitis, a rare allergic disease of the esophagus, was recently recognized as a distinct entity in children. Esophage-al eosinophilia is the main histopathologic finding for its diagnosis, though it may be seen in various types of esophagitis. We, therefore, set out to evaluate the discriminatory value of currently available histologic criteria in the diag-nosis of eosinophilic esophagitis in children. Materials and methods: We ret-rospectively evaluated the esophageal biopsies of 145 children, admitted to Ankara University Medical School hospital, who suffered from gastrointestinal symptoms, between 2007 and 2011, and retrieved 7 cases of clinically confir-med eosinophilic esophagitis. The presence of papillary elongation, dilatation of intercellular spaces and basal cell hyperplasia was noted together with the number of intraepithelial eosinophils, neutrophils, and lymphocytes per high-power field. Presence of necrosis/erosions, subepithelial inflammation and fib-rosis, vascular congestion, and intestinal metaplasia was also recorded. Pati-ents' medical records to retrieve data regarding demographic information, cli-nical presentation, laboratory data, endoscopic findings and the response to treatment received before upper gastrointestinal endoscopy.Results: The age of the patients ranged from 6-17 years with a mean age of 10.57±3.42 years. There were 3 boys and 4 girls. Endoscopic abnormalities such as white exu-dates and furrowing were found in three patients while four had normal en-doscopy. Basal cell hyperplasia was found in three cases while papiller elon-gation was observed in 6 cases, three of which were mild and three were se-vere. Dilated intercellular spaces was observed in four cases, two of which we-re mild and two were severe. Eosinophilic microabscesses were observed in all cases. Median eosinophil count was 25 (min:12; max:78), while median lymphocyte count was 9 (min:2; max:33) within the squamous epithelium. No intraepithelial neutrophils were present. Conclusion: Histopathologic pa-rameters such as epithelial eosinophilia (>15/hpf), eosinophilic microabsces-ses and superficial crowding of eosinophils seem to be the main diagnostic cri-teria for eosinophilic esophagitis in childhood in the correct clinical context. Basal cell hyperplasia, papillary elongation and dilatation of intercellular spa-ces seem to be less discriminatory for the diagnosis of eosinophilic esophagi-tis as they represent reactive changes to injury.

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