"This is the first quantitative assessment of how eosinophils are distributed in the esophagus," says co-author Gerald Gleich, professor of dermatology at the University of Utah and specialist in eosinophil-related diseases. "Until now, someone would go in and snip around, but they wouldn't have this map to quantify the degree of infiltration of this disease in relationship to the actual anatomy. These findings impact how many biopsies a doctor should perform."
Since eonsinophils are scattered within the esophagus, EoE can go undetected until severe symptoms surface, ranging from painful swallowing to chest pains that mimic a heart attack.
"This is not the ideal way to diagnose EoE," says Pease. "If the distribution of eosinophils was 100 percent uniform, it wouldn't matter where you sample, but in fact it's patchy. Our mapping shows if you sample in one region, no diagnosis would be made, but if you took another region about an inch away, the same patient would appear to be severely diseased."
To generate a map of eosinophil distribution in the esophagus, lead author Hedieh Saffari examined each of 17 tissue sections taken at intervals every one-eighth to one-fifth of an inch along the esophagus of a known adult EoE patient. A typical adult esophagus is 10 inches long.
"For every cross section, I used microscopy to count the number of eosinophil cells along the entire perimeter of the tissue surface in each high-power field of view image," said Saffari, a chemical engineering graduate student. "There were somewhere between 40 and 120 of these images per cross section so it took a lot of time, but it was worth it to extract the information we were looking for. No one has done this type of mapping before."
Saffari's diligence paid off. With her painstakingly collected data, she and Pease used a statistical simulation technique to determine whether randomly sampling tissu
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University of Utah