From the Guidelines
No, eosinophilic esophagitis (EoE) typically does not cause significantly elevated eosinophilia in the blood. While EoE is characterized by a high concentration of eosinophils in the esophageal tissue (≥15 eosinophils per high-power field) as defined by the British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines 1, peripheral blood eosinophilia is not a consistent finding. The guidelines emphasize the importance of oesophageal histology showing a peak eosinophil count of ≥15 eosinophils/high power field (or ≥15 eosinophils/0.3 mm² or >60 eosinophils/mm²) for diagnosis, without mentioning significant peripheral eosinophilia as a diagnostic criterion 1.
The pathophysiology of EoE involves a localized immune response in the esophagus, primarily triggered by food allergens or environmental factors, leading to eosinophil recruitment specifically to the esophageal tissue rather than systemic eosinophilia. Key points to consider include:
- The condition is characterized by symptoms of dysphagia and/or food impaction in adults, and feeding problems, abdominal pain and/or vomiting in children 1.
- EoE is a distinct clinicopathological entity with a severe impact on quality of life, defined as a chronic, immune-mediated or antigen-mediated oesophageal disease 1.
- Diagnosis relies on endoscopic biopsies of the esophagus rather than blood tests, as tissue examination is necessary to confirm the characteristic eosinophilic infiltration and exclude other causes of esophageal symptoms.
Given the localized nature of EoE and the lack of significant peripheral eosinophilia in most cases, blood eosinophil counts are not a reliable diagnostic tool for EoE, and diagnosis should be based on clinical presentation and histological findings from esophageal biopsies, as recommended by the guidelines 1.
From the Research
Eosinophilic Esophagitis and Blood Eosinophilia
- Eosinophilic esophagitis is a chronic immunogenic-antigen mediated disease of the esophagus, characterized by symptoms related to esophagus dysfunction and histologically defined by over 15 eosinophil counts seen in high-power microscopic field 2.
- The condition is often associated with dysphagia, reflux, chest pain, regurgitation, and bolus impaction in adults 2, 3.
- Studies have shown that eosinophilic esophagitis can coexist with gastroesophageal reflux disease, and treatment with proton pump inhibitors or topical corticosteroids can lead to symptom improvement and a decrease in esophageal eosinophil counts 3, 4.
Eosinophilia in Blood
- There is no direct evidence to suggest that eosinophilic esophagitis typically causes significantly elevated eosinophilia in the blood 2, 3, 4, 5, 6.
- Eosinophilic esophagitis is characterized by increased eosinophils isolated to the esophagus, and the condition is often diagnosed based on esophageal biopsy and symptom assessment 5.
- While some studies have reported on the clinical and histologic findings of eosinophilic esophagitis, none of the studies provided have specifically addressed the question of whether eosinophilic esophagitis causes elevated eosinophilia in the blood.
Clinical Implications
- Eosinophilic esophagitis is a distinct entity that requires proper diagnosis and treatment, and clinicians should be aware of the condition's clinical presentation, diagnosis, and management 3, 5.
- Treatment options for eosinophilic esophagitis include proton pump inhibitors, topical corticosteroids, and dietary restriction, and the choice of treatment depends on the individual patient's symptoms and response to therapy 3, 4, 5.