The Comparison of Eosinophilic Esophagitis and Gastro-esophageal Reflux Disease

Lee, Ho Chul; Cho, Han Jin; Park, Kwan Sik; Seo, Woon Hee; Lee, Hyun Suk; Choi, So Young; Jun, Sung Woo

Abstract

Eosinophilic esophagitis (EE) is an increasingly recognized disorder in adults characterized by intense eosinophilic infiltration of the esophageal mucosa and results in clinical signs and symptoms that may be indistinguishable from those of gastroesophageal reflux disease (GERD). This study was performed to define clinicopathologic characteristics of EE, which could be distinguishable from GERD. Esophageal biopsies from 22 patients with dysphagia or esophagitis were reviewed blindly. Eosinophilic esophagitis was diagnosed with epithelial eosinophils > or =15 in 2 high-power fields (HPF) or > or =20 in any HPF. Clinical and endoscopic findings were obtained. Of 22 patients, eosinophilic esophagitis were 12 patients (male 8, female 4, mean age 60.08) and non-eosinophilic esophagitis were 10 patients (male 8, female 2, mean age 58). Most common symptom in EE was dysphagia (5 out of 12, p=0.04), while heartburn in non-EE (7 out of 10, p=0.027). Mucosal fragility proved to be the only statistically significant endoscopic finding in EE, while other findings insignificant between two groups. EE, often misdiagnosed as GERD, is therefore, exposed to long-term inadequate treatment. Endoscopic esophageal biopsy is required for those who have dysphagia for a long time and mucosal fragility in endoscopic finding. Patients, whose eosinophilic count is over 20/HPF in biopsy, need avoidance of food and allergen, anti-inflammatory treatment as local or systemic steroid.