Journal of Pharmacy and Pharmacology 6 (2018) 604-612 doi: 10.17265/2328-2150/2018.06.008 Endoscopic Classification of Esophagic Eosinophilia Augusto Fey 1,2 , Lorete Maria da Silva Kotze 2 and Mônica Serapião 1 1. Faculty of Medicine, UNIDAVI, Rio do Sul 89160-932, Brazil 2. Department of Health Sciences, Pontifical Catholic University, Curitiba 80215-901, Brazil Abstract: Introduction: EoE (eosinophilic esophagitis) is an inflammatory condition characterized by a dense eosinophilic infiltrate in the esophageal epithelium. In Brazil, it remains a poorly diagnosed disease due to the lack of interaction between the clinician, the endoscopist, and the pathologist. The diagnosis is performed by histological study of esophageal biopsies, with at least fifteen eosinophils per high-power field (EOS/HPF). Some doubts remain with respect to patients with a clinical picture and symptoms compatible with the disease (EoE), but who have a lower number of eosinophils than established. The main objective of this study was to create an endoscopic classification for EsEo (esophageal eosinophilia), which pointed the way to the endoscopist towards the diagnosis. Methods: This study was a prospective, two-year study, at a gastrointestinal endoscopy center where all patients with endoscopic symptoms and/or endoscopic findings suggestive of EsEo were biopsied for histological examination of EOS/HPF. After the study and compilation of the results, a retrospective study was performed, based on a review of electronic medical records, where the same diagnosis was searched, although at a period when this classification was not adopted. Results: A total of 4,251 endoscopies were performed between September 2011 and September 2013. Two biopsies were performed, aimed at lesions, in 133 patients with clinical picture or imaging suggestive of EsEo. Eosinophils were found in 55 patients, corresponding to an incidence of 1.29% of the total population studied and 41.35% of the suspected cases of the disease. EoE was diagnosed in 24 patients during the period of this study. In the two-year retrospective study, only two cases of EoE were found. Conclusions: The results of this study demonstrate that the endoscopic standardization of esophageal lesions, suggestive of eosinophilia, in this case by classification, alerts the endoscopist for the diagnosis of EoE, prompting him to perform targeted biopsies. Further, it was observed that two samples of esophageal tissue were sufficient for the diagnosis. The relationship between the clinical picture, endoscopy, and histology was not evident in this study. Key words: Endoscopic classification, eosinophilic esophagitis, esophageal eosinophilia, esophagus, eosinophils. 1. Introduction EoE (eosinophilic esophagitis) is an inflammatory condition characterized by a dense eosinophilic infiltrate in the esophageal epithelium [1]. The disease has pathophysiological mechanisms similar to allergy, also known as allergic esophagitis, clinically evolving as a chronic disease, with periods of exacerbation and high gastrointestinal symptoms [2, 3]. This pathology is well known in the pediatric population, but only recently studied in adults and therefore still poorly diagnosed in this age group [1]. With the increase of the diagnosis the prevalence has been increasing, reaching 43 cases per 100,000 inhabitants [4]. It is the main cause of food impaction Corresponding author: Augusto Fey, Ph.D., M.D., senior lecturer, research fields: endoscopy and gastroenterology. in young adults [5]. The preponderant age group ranges between 20 and 40 years [6] and is more frequent in men [2, 3]. There is a family and personal history of allergy in a considerable number of patients and the disease may have a familiar character in up to 10% of cases [7]. Some studies demonstrate the association of EoE with GERD (gastroesophageal reflux disease) in up to 40% of cases [8]. EoE may also be related with other inflammatory diseases, including the association between celiac disease [9] and other allergic diseases, such as asthma, allergic rhinitis, and atopic dermatitis [10]. The pathogenesis of EoE is still not fully understood, but it is known that differentiation of eosinophils from precursor cells in the bone marrow occurs from an antigenic, respiratory, or gastrointestinal stimulus [2]. Activation of eosinophils occurs in the tissues, which D DAVID PUBLISHING