Background: Eosinophilic esophagitis (EoE) has emerged as a leading cause of dysphagia
in adults. Characteristic esophageal features on endoscopy include structural/fibrostenotic
(rings, narrow caliber, strictures) and inflammatory manifestations (longitudinal furrows,
exudates, edema). Aim: The purpose of this study was to correlate the clinical, endoscopic
and histopathologic features in adult EoE patients. Methods: A total of 106 encounters of
81 patients with EoE were analyzed. Data included an EoE-directed symptom-severity patient
questionnaire evaluating symptoms of dysphagia (frequency, intensity, duration), meal duration,
chest pain, and overall symptom severity. Video recordings of endoscopies were reviewed
in a blinded manner using a classification and grading scheme for the esophageal features of
EoE. Histopathology was reviewed for peak eosinophil count/high power field by pathologists
blinded to the patients' clinical status. Associations between endoscopic features, histology
and symptoms were evaluated using the Spearman rank correlation analysis. Results: The
endoscopic severity of both structural and inflammatory esophageal features of EoE, including
rings, exudates, longitudinal furrows, and edema, correlated significantly with peak eosinophil
counts (see Table 1). Presence of "crepe paper mucosa" did not demonstrate significant
association with peak eosinophil counts. Both structural (rings, narrow-caliber esophagus
and strictures) and inflammatory (furrows, exudates and edema) composite endoscopic scores
demonstrated a strong correlation with peak eosinophil counts. The strongest association with
the degree of esophageal eosinophilia was found with a combination of both structural and
inflammatory findings (p < 0.0001). The esophageal diameter (in mm) was negatively
correlated with overall symptom severity (Spearman's rho = -0.4883, P = 0.0339). None of
the individual or combined patient reported symptoms correlated significantly with either
endoscopic or histopathologic findings. Conclusion: The severity of both structural and
inflammatory endoscopic features associated with EoE is significantly associated with the
degree of esophageal eosinophilia. Patient reported symptom severity was not associated
with the degree of esophageal eosinophilia. Esophageal stricture diameter was inversely
correlated with EoE symptom severity. The prognostic and therapeutic implications of these
observations need to be determined.