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A Pathologic or Clinicopathologic Diagnosis?

Matthew T. Brigger, MD, LCDR, MC, USNR; Joseph Misdraji, MD; Stephen C. Hardy, MD; Christopher J. Hartnick, MD, MEpi

Arch Otolaryngol Head Neck Surg. 2009;135(1):95-100.

Objective  To determine the accuracy of histopathologic diagnosis in distinguishing eosinophilic esophagitis (EE) from gastroesophageal reflux disease (GERD) in children with upper aerodigestive symptoms.

Design  Masked review of esophageal biopsy findings and comparison with each child's established clinical diagnosis.

Setting  A tertiary care multidisciplinary aerodigestive center.

Patients  Children were selected from a longitudinal database of all children referred for upper aerodigestive symptoms who underwent a comprehensive evaluation between September 1, 2004, and September 1, 2007. Three groups were recognized based on clinical presentation, initial histologic review, and therapeutic response: children with EE, GERD, or neither.

Intervention  Review of esophageal biopsy findings by a pathologist masked to the child's clinical or previous pathologic diagnosis.

Main Outcome Measure  Masked histopathologic diagnosis of EE, GERD, or neither.

Results  Medical records from 31 patients were reviewed (11 children with EE, 10 with GERD, and 10 with neither). Diagnostic concurrence between the masked pathologic diagnosis and the established clinicopathologic diagnosis was 64% in children with EE, 70% in children with GERD, and 100% in children with neither. The 4 cases of EE that did not concur were misclassified as GERD when esophageal specimens were evaluated by histopathologic means alone. A clinicopathologic schema for EE developed by gastroenterologists accurately identified 82% of children with EE.

Conclusions  The distinction between EE and GERD cannot be reliably made on histopathologic evidence alone in children with upper aerodigestive symptoms. Despite the recent gastroenterology consensus statement regarding the clinicopathologic diagnosis of EE, children with primary airway symptoms in whom EE is suspected represent a diagnostic dilemma.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary (Drs Brigger and Hartnick), and Departments of Pathology (Dr Misdraji) and Pediatric Gastroenterology and Nutrition (Dr Hardy), Massachusetts General Hospital, Harvard Medical School, Boston.

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