Normal values of eosinophils in gastric and duodenal mucosa of children referred to upper gastrointestinal endoscopy

Abstract

With the increasing incidence of food allergies, the presence of eosinophils (Eos) in the gastrointestinal mucosa has received increased attention, particularly in the esophagus and colon. However, normal values for the Eos count in the stomach and duodenum in pediatric patients are still limited. The objective of this study was to estimate Eos reference values in stomach and duodenal biopsies of children referred to upper gastrointestinal endoscopy. Patients and Methods: Cross-sectional study of biopsies from symptomatic children referred to upper gastrointestinal endoscopy. The endoscopic report, Rapid Urease Test for the presence of H. pylori, and the quantitative histological evaluation (number of cells/HFP, high power field) were analyzed. The Eos distribution is described as mean and standard deviation, and also as percentiles since the counts did not have a normal distribution. Statistical analysis included χ2 test, Wilcoxon test, analysis of variance, and linear regression curves were evaluated as appropriate. Results: Of the 170 patients referred to endoscopy, 72 met “normal” criteria (normal endoscopy in macroscopic analysis, negative Rapid Urease Test, and normal biop-sy). The median age was 11 years (range 4-16), and 68% were girls. The Eos count (mean ± 1SD) in gastric antrum (n = 72) was 1.13 ± 1.79 Eos/HPF; in gastric body (n = 27), 1.06 ± 1.79 Eos/HPF; and in duodenum (n = 30), 10.44 ± 7.09 Eos/HPF. There were no significant differences by age and sex, or by H. pylori infection (p = 0.095). Conclusions: We propose an Eos count of 0-3 Eos/HPF for the gastric body, 0-3 Eos/HPF in the antrum, and 3-17 Eos/HPF in the duodenum as a normal range for gastric mucosa in children. This study suggests that in areas with a high prevalence of H. pylori infec-tion, the count of Eos does not seem to be a distinctive element and that Eos are commonly present in the gastroduodenal mucosa.