Avaliação do remodelamento tecidual em biópsias de pacientes portadores de esofagite eosinofílica

Abstract

Eosinophilic esophagitis is of increasing importance in the medical literature. It is a chronic inflammatory disease, mediated immunoantigen, characterized by symptoms of esophageal dysfunction and a predominantly eosinophilic infiltration in the esophagic mucosa. The histopathological diagnosis is defined by the presence of 15 or more eosinophils per large increase field and the treatment of each patient should be individualized. The process of esophageal remodeling into eosinophilic esophagitis is still not fully understood, but it seems to involve a presence of fibrosis in the lamina propria, being a major cause of the symptoms of dysphagia and food impaction. IL-13 counteracts the expression of filaggrin in epithelial cells, promoting a mechanism by which food antigens activate the immune system. This study aimed to evaluate a prevalence of the histopathological characteristics of tissue remodeling and the filaggrin expression in esophageal biopsies of patients with eosinophilic esophagitis. Fifty patients with clinical and/or endoscopic suspicion of eosinophilic esophagitis were retrospectively evaluated. Of these, 27 were selected and distributed in two groups: GI, with 15 to 24 eosinophils per large increase field and GII, containing more than 24. After a histomorphometry and immunohistochemistry for filaggrin, the two groups were compared. In the fibrosis parameters, there was a statistically significant difference, with a higher prevalence in GII (p < 0.05). There was also more thickening of the basal layer in GII (p < 0.001). The correlation study between the number of eosinophils and the percentage of fibrosis found a positive correlation: 50.8% (p = 0.016), that means, more fibrosis in cases of GII. In the correlation between the number of eosinophils and the thickness of the basal layer, the result was also positive: 52.1% (p = 0.08), that means, thicker basal layer in GII. Filaggrin was reduced in patients with eosinophilic esophagitis.