A. Joe Saad, MD1, Kevin Turner, DO2, Amol P. Kamboj, MD3, Evan S. Dellon, MD, MPH, FACG4, Mirna Chehade, MD, MPH5, Robert M. Genta, MD, FACG6 1Methodist Dallas Medical Center, University of Texas Southwestern Medical Center, Dallas, TX; 2UT Southwestern, Dallas, TX; 3Allakos, Inc., Redwood City, CA; 4University of North Carolina School of Medicine, Chapel Hill, NC; 5Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, NY; 6Inform Diagnostics, Irving, TX
Introduction: Pathologists’ awareness of eosinophilic gastritis (EG) and duodenitis (EoD) may be limited—biopsy requisitions rarely mention EG or EoD. We investigated whether providing patient histories of allergic and eosinophilic disorders affects pathologists’ search for eosinophils in gastric and duodenal biopsies and mentions of EG and EoD in reports.
Methods: We performed a study of 20 general pathologists who completed their residencies ≥5 years ago and analyze ~25% gastrointestinal biopsies in their practices. Pathologists were given hematoxylin and eosin-stained sections (antral, oxyntic, and duodenal mucosa) from 16 patients. Nine cases had as many as 85 eosinophils/high-power field in gastric and/or duodenal tissues (confirmed by 2 expert GI pathologists); 5 cases had H pylori gastritis, 1 case had atrophic gastritis, 1 case had normal stomach but duodenal lymphocytosis, and 1 case had celiac sprue. Pathologists were randomly assigned to 2 groups of n=10: group A received a succinct history of each case (eg, “30-year-old man with dyspepsia and vomiting”) and group B received the same histories along with mentions of possible gastrointestinal eosinophilic disorders (eg, “history of atopic dermatitis; 1500 eosinophils/µL in peripheral blood”). Pathologists received a list of common and uncommon gastric and duodenal diagnoses, including EG and EoD, and were asked to make selections; a space for comments was provided. Results were analyzed descriptively.
Results: All pathologists correctly diagnosed non-eosinophilic disorders (H pylori gastritis, atrophic gastritis, and celiac sprue) indicating competence in GI pathology. Gastric eosinophilia was noted by 1 pathologist in group A and 2 pathologists in group B; none selected the diagnosis of “eosinophilic gastritis.” Duodenal eosinophilia was noted by 2 pathologists in group A and 3 in group B, but the diagnosis EoD was made only once (group B). With this exception, no pathologists diagnosed EG/EoD and none quantified eosinophils. Mentions of possible eosinophilic gastrointestinal disorders had minimal effects on pathologists’ evaluations of the biopsies.
Discussion: Most pathologists do not mention gastric or duodenal eosinophilia in their reports, even for patients with reported histories of eosinophilic disorders. Specific training of pathologists, increased awareness of EG and EoD among gastroenterologists, and their direct request for evaluation of eosinophilia might increase identification of patients with EG and/or EoD.
A. Joe Saad: Allakos, Inc – Advisory Committee/Board Member.
Kevin Turner: Adare – Consultant. Allakos, Inc – Consultant.
Robert Genta: Adare/Ellodi – Consultant. Allakos, Inc – Consultant. Inform Diagnostics – Employee. Red Hill Pharmaceuticals – Consultant.
A. Joe Saad, MD1, Kevin Turner, DO2, Amol P. Kamboj, MD3, Evan S. Dellon, MD, MPH, FACG4, Mirna Chehade, MD, MPH5, Robert M. Genta, MD, FACG6. P1445 - General Pathologists Do Not Routinely Evaluate Gastric or Duodenal Eosinophilia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.