Erica J Brenner1, Sydney B Greenberg2, Nicole C Chang3, S Ryanne Corder4, Ellen L Cowherd5, Evan S Dellon6. 1. University of North Carolina Department of Pediatric Gastroenterology, Center for Gastrointestinal Biology and Disease, 333 S. Columbia St. 247 MacNider Hall, CB# 7229, Chapel Hill 27599, NC, United States. Electronic address: Erica.Brenner@unchealth.unc.edu. 2. University of North Carolina Department of Medicine, 333 S. Columbia St. 126 MacNider Hall, CB# 7005, Chapel Hill 27599, NC, United States. Electronic address: Sydney.Greenberg@unchealth.unc.edu. 3. University of North Carolina Center for Esophageal Diseases and Swallowing, Bioinformatics Building, 130 Mason Farm Rd, CB# 7555, Chapel Hill 27599, NC, United States. Electronic address: nicole_chang@med.unc.edu. 4. University of North Carolina Center for Esophageal Diseases and Swallowing, Bioinformatics Building, 130 Mason Farm Rd, CB# 7555, Chapel Hill 27599, NC, United States. Electronic address: stephanie_corder@med.unc.edu. 5. University of North Carolina Department of Pediatrics, 333 S. Columbia St. 260 MacNider Hall, CB# 7220, Chapel Hill 27599, NC, United States. Electronic address: ellen_cowherd@med.unc.edu. 6. University of North Carolina Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, Bioinformatics Building, 130 Mason Farm Rd, CB# 7555, Chapel Hill 27599, NC, United States. Electronic address: evan_dellon@med.unc.edu.
Abstract
BACKGROUND: Gastric and duodenal mucosa may appear normal in eosinophilic gastroenteritis (EGE). Adult gastroenterologists typically biopsy only in the setting of mucosal abnormalities or symptoms, while pediatric providers biopsy all patients. The biopsy yield of EGE has not been adequately evaluated. AIMS: To evaluate the biopsy yield of EGE in a pediatric cohort and assess predictors of increased biopsy yield. METHODS: We identified patients age 0-18 who underwent upper endoscopy. We recorded endoscopic findings, pathology, demographics, and clinical and laboratory characteristics. We identified EGE cases (>20 eosinophils per high-power field on stomach and/or duodenum biopsy). We compared characteristics between EGE and non-EGE cases, calculated biopsy diagnostic yield, and performed multivariate analysis for predictors of increased biopsy yield. RESULTS: In 509 patients (55.6% female, mean age 10.3 years, 69.7% white, 58.7% atopic), biopsy diagnostic yield for EGE was 1.2% (6/509) among all subjects, 7.7% (3/39) for those with peripheral eosinophilia (≥500 eos/uL), 9.1% (3/33) for those with hypoalbuminemia (<3.5 g/dL), and 25.0% (3/12) for those with peripheral eosinophilia and hypoalbuminemia. The odds of EGE were 27.8 (95% CI 3.3-231.8) times greater among those with peripheral eosinophilia. The mean total biopsy surface area and number of fragments was similar between patients with and without EGE. The area under the ROC curve for blood eosinophil counts and albumin level for predicting EGE was 0.926. CONCLUSIONS: The biopsy diagnostic yield for EGE is low but increases with peripheral eosinophilia and hypoalbuminemia. Patients with these features should have biopsies obtained, regardless of endoscopic appearance.
BACKGROUND: Gastric and duodenal mucosa may appear normal in eosinophilic gastroenteritis (EGE). Adult gastroenterologists typically biopsy only in the setting of mucosal abnormalities or symptoms, while pediatric providers biopsy all patients. The biopsy yield of EGE has not been adequately evaluated. AIMS: To evaluate the biopsy yield of EGE in a pediatric cohort and assess predictors of increased biopsy yield. METHODS: We identified patients age 0-18 who underwent upper endoscopy. We recorded endoscopic findings, pathology, demographics, and clinical and laboratory characteristics. We identified EGE cases (>20 eosinophils per high-power field on stomach and/or duodenum biopsy). We compared characteristics between EGE and non-EGE cases, calculated biopsy diagnostic yield, and performed multivariate analysis for predictors of increased biopsy yield. RESULTS: In 509 patients (55.6% female, mean age 10.3 years, 69.7% white, 58.7% atopic), biopsy diagnostic yield for EGE was 1.2% (6/509) among all subjects, 7.7% (3/39) for those with peripheral eosinophilia (≥500 eos/uL), 9.1% (3/33) for those with hypoalbuminemia (<3.5 g/dL), and 25.0% (3/12) for those with peripheral eosinophilia and hypoalbuminemia. The odds of EGE were 27.8 (95% CI 3.3-231.8) times greater among those with peripheral eosinophilia. The mean total biopsy surface area and number of fragments was similar between patients with and without EGE. The area under the ROC curve for blood eosinophil counts and albumin level for predicting EGE was 0.926. CONCLUSIONS: The biopsy diagnostic yield for EGE is low but increases with peripheral eosinophilia and hypoalbuminemia. Patients with these features should have biopsies obtained, regardless of endoscopic appearance.
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