Application of the Eosinophilic Esophagitis Histology Scoring System Grade Scores in Patients at British Columbia Children's Hospital

Introduction Histologic diagnosis of eosinophilic esophagitis (EoE) involves peak eosinophil counts (PEC) being greater than 15 per high power field. The EoE Histology Scoring System (EoEHSS) was developed to comprehensively evaluate biopsies to better predict symptom and endoscopy response; we aimed to validate the EoEHSS in our provincial registry, where EoEHSS had not been employed. Methods We reviewed 186 esophageal biopsies from 16 patients at diagnosis and follow-up. Statistical analyses were conducted to quantify how grade scores correlate with active EoE status and PEC counts, and each feature's ability to predict active disease. Results Nearly all EoEHSS variables were associated with active EoE and high PEC, with basal zone hyperplasia, eosinophil abscesses, and surface epithelial alteration being most predictive in identifying active EoE. Conclusions We validated and demonstrated each EoEHSS variable's strength in tracking traditional PEC counts, resulting in its adoption as a standard reporting element for our research registry.

Automated summary

The study aimed to validate and apply the EoEHSS for predicting symptoms and endoscopy response in eosinophilic esophagitis (EoE). The results showed that almost all EoEHSS variables were significantly associated with active EoE and high PEC, with basal zone hyperplasia, eosinophil abscesses, and surface epithelial alteration being the most predictive features for identifying active EoE.