Beige mucosa observable under narrow-band imaging indicates the active sites of eosinophilic esophagitis - PubMed (original) (raw)
. 2022 May;37(5):891-897.
doi: 10.1111/jgh.15808. Epub 2022 Mar 9.
Affiliations
- PMID: 35229352
- PMCID: PMC9311190
- DOI: 10.1111/jgh.15808
Beige mucosa observable under narrow-band imaging indicates the active sites of eosinophilic esophagitis
Maki Ayaki et al. J Gastroenterol Hepatol. 2022 May.
Abstract
Background and aim: The majority of patients with eosinophilic esophagitis (EoE) are likely to have observable features under narrow-band imaging, namely beige mucosa. However, the histological features and clinical implications of beige mucosa have not been investigated. The aim of this study was to determine whether beige mucosa could serve as an endoscopic marker for predicting active inflammatory sites of EoE.
Methods: We retrospectively analyzed both the narrow-band images and biopsied specimens of 77 esophageal lesions from 35 consecutive patients with EoE. We divided these specimens into two groups: target biopsied specimens from beige mucosa (beige group) and specimens biopsied from non-beige mucosa (non-beige group). The number of eosinophils per high-powered field, thickness of the superficial differentiated cell layer, and depth of the hemoglobin component from the surface layer were compared between the two groups.
Results: Forty-four out of the 45 specimens were diagnosed as histological active lesions in the beige group. The sensitivity, specificity, and overall accuracy of beige mucosa in predicting EoE activity were 97.8%, 96.9%, and 97.8%, respectively. Compared with the non-beige group, specimens in the beige group had a significantly thinner superficial differentiated cell layer.
Conclusions: Beige mucosa is associated with thinning of the normal superficial differentiated cell layer, and these histological changes in the active inflammatory sites of EoE could be recognized endoscopically as color differences. Beige mucosa may serve as an endoscopic indicator for predicting the histological activity of EoE.
Keywords: beige mucosa; diagnosis; endoscopic finding; eosinophilic esophagitis; narrow-band imaging.
© 2022 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Figures
Figure 1
Beige mucosa. Representative endoscopic findings of the beige mucosa, defined as light brownish areas on narrow‐band imaging (yellow square). Non‐beige mucosa, defined as areas of light green epithelium (white square). [Color figure can be viewed at
wileyonlinelibrary.com
]
Figure 2
Schematic representation of the interactions between tissue and short wavelength of 415 nm (blue bands) when using narrow‐band imaging: (a) in normal epithelium, the blue bands are reflected by the surface of the differentiated squamous cell layer. (b) In active inflammatory sites of EoE, the blue bands are allowed to contact the Hb component due to the loss or thinning of the superficial differentiated squamous cell layer. EoE, eosinophilic esophagitis; Hb, hemoglobin. [Color figure can be viewed at
wileyonlinelibrary.com
]
Figure 3
Endoscopic images of eosinophilic esophagitis: (a) morphological changes can be seen in both white‐light imaging and narrow‐band imaging (NBI), and the inflammatory area can be recognized by the color change of the beige mucosa under NBI observation. (b) Characteristic endoscopic findings of eosinophilic esophagitis, such as furrows, rings, or exudates, were not clearly observed, but beige mucosa was detected by NBI. [Color figure can be viewed at
wileyonlinelibrary.com
]
Figure 4
Representative immunohistological images of beige mucosa and non‐beige mucosa stained with anti‐human Hb antibody (anti‐Hb Ab). Left image: Beige mucosa with no differentiated cell layer and intense positivity to anti‐Hb Ab throughout the epithelium, including the superficial layer. Right image: Non‐beige mucosa has a thick differentiated cell layer (black arrow), and this area is negative for anti‐Hb Ab. Hb, hemoglobin. [Color figure can be viewed at
wileyonlinelibrary.com
]
Figure 5
Box‐whisker plots showing comparisons of the beige and non‐beige groups regarding the (a) depth from the surface layer to the hemoglobin component and (b) differentiated cell layer thickness. [Color figure can be viewed at
wileyonlinelibrary.com
]
Figure 6
Representative endoscopic images of beige mucosa with narrow‐band imaging under less air and standard air conditions. (a–c) Upper image: less air condition. Lower image: standard air condition. [Color figure can be viewed at
wileyonlinelibrary.com
]
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References
- Gono K, Obi T, Yamaguchi M et al. Appearance of enhanced tissue features in narrow‐band endoscopic imaging. J. Biomed. Opt. 2004; 9: 568–577. - PubMed
- Ichiya T, Tanaka K, Rubio CA et al. Evaluation of narrow‐band imaging signs in eosinophilic and lymphocytic esophagitis. Endoscopy 2017; 49: 429–437. - PubMed
- Hirano I, Moy N, Heckman MG et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013; 62: 489–495. - PubMed
- Kuehni RG. Color‐tolerance data and the tentative CIE 1976 Lab formula. J. Opt. Soc. Am. 1976; 66: 497–500. - PubMed
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