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Difference between revisions of "Eosinophilic esophagitis"
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Eosinophilic esophagitis (view source)
Revision as of 15:33, 10 December 2013
, 15:33, 10 December 2013→Microscopic: clean-up a bit
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Notes "abundant eosinophils": | Notes "abundant eosinophils": | ||
*Criteria for number of eosinophils/area is '''''highly variable'''''; there is a 23X fold variation in published values and only 11% of studies actually define an area (most studies | *Criteria for number of eosinophils/area is '''''highly variable'''''; there is a 23X fold variation in published values and only 11% of studies actually define an area (most studies, only give the number of eosinophils per "HPF")!<ref name=pmid17617209>{{cite journal |author=Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ |title=Variability in diagnostic criteria for eosinophilic esophagitis: a systematic review |journal=Am. J. Gastroenterol. |volume=102 |issue=10 |pages=2300–13 |year=2007 |month=October |pmid=17617209 |doi=10.1111/j.1572-0241.2007.01396.x |url=}}</ref> | ||
**Interrater variability is low, i.e. good, if the procedure is standardized.<ref name=pmid19830560>{{Cite journal | last1 = Dellon | first1 = ES. | last2 = Fritchie | first2 = KJ. | last3 = Rubinas | first3 = TC. | last4 = Woosley | first4 = JT. | last5 = Shaheen | first5 = NJ. | title = Inter- and intraobserver reliability and validation of a new method for determination of eosinophil counts in patients with esophageal eosinophilia. | journal = Dig Dis Sci | volume = 55 | issue = 7 | pages = 1940-9 | month = Jul | year = 2010 | doi = 10.1007/s10620-009-1005-z | PMID = 19830560 }}</ref> | **Interrater variability is low, i.e. good, if the procedure is standardized.<ref name=pmid19830560>{{Cite journal | last1 = Dellon | first1 = ES. | last2 = Fritchie | first2 = KJ. | last3 = Rubinas | first3 = TC. | last4 = Woosley | first4 = JT. | last5 = Shaheen | first5 = NJ. | title = Inter- and intraobserver reliability and validation of a new method for determination of eosinophil counts in patients with esophageal eosinophilia. | journal = Dig Dis Sci | volume = 55 | issue = 7 | pages = 1940-9 | month = Jul | year = 2010 | doi = 10.1007/s10620-009-1005-z | PMID = 19830560 }}</ref> | ||
*The most commonly reported cut points are 15, 20 and 24 eosinophils/HPF, without defining HPF.<ref name=pmid17617209/> | *The most commonly reported cut points are 15, 20 and 24 eosinophils/HPF, without defining HPF.<ref name=pmid17617209/> | ||
**The ''Foundation Series'' book<ref name=Ref_GLP19>{{Ref GLP|19}}</ref> says: "> 20/HPF"; | **The ''Foundation Series'' book<ref name=Ref_GLP19>{{Ref GLP|19}}</ref> says: "> 20/HPF"; this is problematic as "HPF" is not defined (see [[HPFitis]]). | ||
**There is a consensus paper<ref name=pmid17919504>{{cite journal |author=Furuta GT, Liacouras CA, Collins MH, ''et al.'' |title=Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment |journal=Gastroenterology |volume=133 |issue=4 |pages=1342–63 |year=2007 |month=October |pmid=17919504 |doi=10.1053/j.gastro.2007.08.017 |url=}}</ref> that makes note of [[HPFitis]]... and then goes on to ignore to whole issue by defining EE as 15/HPF | **There is a consensus paper<ref name=pmid17919504>{{cite journal |author=Furuta GT, Liacouras CA, Collins MH, ''et al.'' |title=Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment |journal=Gastroenterology |volume=133 |issue=4 |pages=1342–63 |year=2007 |month=October |pmid=17919504 |doi=10.1053/j.gastro.2007.08.017 |url=}}</ref> that makes note of [[HPFitis]]... and then goes on to ignore to whole issue by defining EE as 15/HPF! | ||
** | **Many microscopes have 22 mm eye pieces and have for their highest magnification objective a 40X. De facto, these people are using the Liacouras ''et al.'' definition.<ref name=pmid16361045>{{cite journal |author=Liacouras CA, Spergel JM, Ruchelli E, ''et al.'' |title=Eosinophilic esophagitis: a 10-year experience in 381 children |journal=Clin. Gastroenterol. Hepatol. |volume=3 |issue=12 |pages=1198–206 |year=2005 |month=December |pmid=16361045 |doi= |url=}}</ref> | ||
*Eosinophils may be patchy.<ref name=pmid22502795>{{Cite journal | last1 = Saffari | first1 = H. | last2 = Peterson | first2 = KA. | last3 = Fang | first3 = JC. | last4 = Teman | first4 = C. | last5 = Gleich | first5 = GJ. | last6 = Pease | first6 = LF. | title = Patchy eosinophil distributions in an esophagectomy specimen from a patient with eosinophilic esophagitis: Implications for endoscopic biopsy. | journal = J Allergy Clin Immunol | volume = 130 | issue = 3 | pages = 798-800 | month = Sep | year = 2012 | doi = 10.1016/j.jaci.2012.03.009 | PMID = 22502795 }}</ref> | *Eosinophils may be patchy.<ref name=pmid22502795>{{Cite journal | last1 = Saffari | first1 = H. | last2 = Peterson | first2 = KA. | last3 = Fang | first3 = JC. | last4 = Teman | first4 = C. | last5 = Gleich | first5 = GJ. | last6 = Pease | first6 = LF. | title = Patchy eosinophil distributions in an esophagectomy specimen from a patient with eosinophilic esophagitis: Implications for endoscopic biopsy. | journal = J Allergy Clin Immunol | volume = 130 | issue = 3 | pages = 798-800 | month = Sep | year = 2012 | doi = 10.1016/j.jaci.2012.03.009 | PMID = 22502795 }}</ref> | ||