Validation of the diagnosis of eosinophilic esophagitis based on histopathology reports in Sweden

  • Lovisa Röjler Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
  • Ida Glimberg Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
  • Marjorie M. Walker Department Anatomical Pathology, Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
  • John J. Garber Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  • Jonas F. Ludvigsson Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK; and Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA
Keywords: Eosinophilic esophagitis, inflammation, validation, histopathology


Background: Eosinophilic esophagitis (EoE) is a relatively new diagnosis, where until recently a specific international classification of disease code was missing. One way to identify patients with EoE is to use histopathology codes. We validated the clinicopathological EoE diagnosis based on histopathology reports and patient charts to establish these data sources as the basis for a nationwide EoE patient cohort.

Methods: Through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study, we randomly selected 165 patients from five Swedish health care regions with a histopathologic diagnosis of EoE. Patients were assigned a histopathology diagnosis of EoE if they had ≥15 eosinophils per high-power field or, in the absence of eosinophil quantification, the pathologist interpreted the biopsy as consistent with EoE. Patient charts were scrutinized to see if the other diagnostic criteria were fulfilled. Of the 131 received patient charts, 111 (85%) had sufficient information to be included in the study.

Results: Of the 111 validated patients, 99 had EoE, corresponding to a positive predictive value of 89% (95% confidence interval = 82–94%). Dysphagia was the most common symptom (n = 78, 70%), followed by food impaction (n = 64, 58%) and feeding difficulties (n = 37, 33%). Twelve patients had coexisting asthma (11%) and 16 allergic rhinitis (14%). Seventeen patients underwent esophageal dilatation (15%), of which seven had more than one dilatation. Ninety-seven (87%) patients had a proton-pump inhibitor treatment ≤2 years before or after the diagnosis. Forty-two patients (38%) had been prescribed inhalation steroids and 64 (58%) had undergone esophageal radiology.

Conclusion: Histopathology reports from the ESPRESSO cohort with esophageal eosinophilic inflammation are suggestive of EoE.


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How to Cite
Röjler L., Glimberg I., Walker M. M., Garber J. J., & Ludvigsson J. F. (2021). Validation of the diagnosis of eosinophilic esophagitis based on histopathology reports in Sweden. Upsala Journal of Medical Sciences, 126(1).
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