Esophageal Epithelium and Lamina Propria Are Unevenly Involved in Eosinophilic Esophagitis

Abstract

Background & aims: The nature of the involvement of esophageal tissue in eosinophilic esophagitis (EoE) is unclear. We estimated the intrabiopsy site agreements of the EoE Histologic Scoring System (EoEHSS) scores for the grade (degree) and stage (extent) of involvement of the esophageal epithelial and lamina propria and examined if the EoE activity status influenced the intrabiopsy site agreement.

Methods: Demographic, clinical, and EoEHSS scores collected as part of the prospective Outcome Measures for Eosinophilic Gastrointestinal Diseases Across Ages study were analyzed. A weighted Cohen's kappa agreement coefficient (k) was used to calculate the pairwise agreements for proximal:distal, proximal:middle, and middle:distal esophageal biopsy sites, separately for grade and stage scores, for each of the 8 components of EoEHSS. A k > 0.75 was considered uniform involvement. Inactive EoE was defined as fewer than 15 eosinophils per high-powered field.

Results: EoEHSS scores from 1263 esophageal biopsy specimens were analyzed. The k for the stage of involvement of the dilated intercellular spaces across all 3 sites in inactive EoE was consistently greater than 0.75 (range, 0.87-0.99). The k for lamina propria fibrosis was greater than 0.75 across some of the biopsy sites but not across all 3. Otherwise, the k for all other features, for both grade and stage, irrespective of the disease activity status, was 0.75 or less (range, 0.00-0.74).

Conclusions: Except for the extent of involvement of dilated intercellular spaces in inactive EoE, the remaining epithelial features and lamina propria are involved unevenly across biopsy sites in EoE, irrespective of the disease activity status. This study enhances our understanding of the effects of EoE on esophageal tissue pathology.

Keywords: Eosinophilic Esophagitis; Epithelial Alterations; Histology Scoring System; Lamina Propria Fibrosis; Peak Eosinophil Counts.

Figure 1:

Number of biopsies analyzed and the distribution of EoEHSS scores (a) grade, and (b) stage. [PE: Proximal esophagus, ME: Middle esophagus, DE: Distal esophagus, EI: Eosinophilic inflammation, BZH: Basal zone hyperplasia, EA: Eosinophilic abscess, SL: Surface layering, DIS: Dilated intercellular spaces, SEA: Surface epithelial alteration DEC: Dyskeratotic epithelial cells, LPF: Lamina propria fibrosis]

Figure 2:

Pairwise analysis of the EoEHSS scores of the initial biopsies. Weighted kappa coefficient for (a) grade, and (b) stage. [P:D: Proximal:Distal, P:M: Proximal:Middle, M:D: Middle:Distal, EI: Eosinophilic inflammation, BZH: Basal zone hyperplasia, EA: Eosinophilic abscess, SL: Surface layering, DIS: Dilated intercellular spaces, SEA: Surface epithelial alteration, DEC: Dyskeratotic epithelial cells LPF: Lamina propria fibrosis] [Weighted kappa coefficient (k): optimal agreement (> 0.75 or even), suboptimal agreement (⩽ 0.75 or uneven)]

Figure 3:

Pairwise analysis of the EoEHSS scores of the initial biopsies to assess the impact of EoE activity on the intra-site agreement. Weighted kappa coefficient for (a) grade, and (b) stage. [P:D: Proximal:Distal, P:M: Proximal:Middle, M:D: Middle:Distal, EI: Eosinophilic inflammation, BZH: Basal zone hyperplasia, EA: Eosinophilic abscess, SL: Surface layering, DIS: Dilated intercellular spaces, SEA: Surface epithelial alteration, DEC: Dyskeratotic epithelial cells, LPF: Lamina propria fibrosis] [Weighted kappa coefficient (k): optimal agreement (> 0.75 or even), suboptimal agreement (⩽ 0.75 or uneven)]