BENEFITS OF ESOPHAGEAL BIOPSIES IN PATIENTS WITH DYSPHAGIA AND NORMAL UPPER ENDOSCOPY

Aims:

Dysphagia frequently reveals organic as well as functional esophageal diseases. Endoscopy sometimes shows few signs or even a macroscopically normal esophagus.

The aim of our study is to evaluate the importance of systematic esophageal biopsies in patients with dysphagia and normal endoscopy, and report the incidence of eosinophilic esophagitis (EoE) which remains a rare entity.

Methods:

Retrospective descriptive study, collecting all patients who had a normal upper endoscopy for dysphagia from June 2015 to June 2017. Esophageal biopsies were done in all patients.

Results:

Eighty-five patients (40 men and 45 women) suffering from chronic dysphagia with normal upper endoscopy were studied. The mean age of our patients was 56 years old (13 to 88 years old). Fifteen patients (29.4%) had past medical history: 9 (10.5%) with Cohn's disease, four patients have been treated for a gastro- esophageal reflux by proton pump inhibitors (PPIs), one patient was diagnosed with multiple myeloma and one other patient had Gougerot-Sjôgren syndrome.

All patients had normal-appearing esophagus in upper endoscopy and they all had biopsies of esophagus.

Histopathological examination revealed normal esophageal mucosa in 65 patients (76%), non-specific esophagitis in eleven cases (12.9%), reflux esophagitis in 4 cases, Barrett's esophagus in one patient, and eosinophilic esophagitis was diagnosed in 4 patients (4.7%) with a good outcome with PPI treatment in 3 cases and topic steroids in 1 patient.

Conclusions:

Our study shows the importance of systematic biopsies in normal esophagus in case of dysphagia as they may enable us to diagnose some rare diseases like eosinophilic esophagitis which can be successfully treated, so that we can avoid many unnecessary costly explorations like manometry. Further studies are to be conducted to confirm the cost effectiveness of systematic biopsies.