Esophageal basal cell nuclear dimensions may be used to distinguish children with eosinophilic esophagitis (EoE) from those with gastroesophageal reflux disease (GERD), according to study  results presented at the American College of Gastroenterology (ACG) 2021 Annual Meeting, held from October 22 to 27, 2021, in Las Vegas, Nevada and virtually.

It is difficult to differentiate between children with EoE and GERD based on their clinical and histologic features. Therefore, researchers evaluated whether esophageal basal cell nuclear morphology can be used to distinguish between these disease states.

The investigators used QuPath v0.2.0 to analyze hematoxylin and eosin (H&E) stain sections of esophageal biopsies obtained from 5 children with EoE and 4 children with GERD; 6 children with esophageal symptoms but no histologic abnormalities were considered controls.

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Basal cells were defined manually, and the basal cell nuclear boundaries were automatically selected by the software. The basal cell nuclear parameters of area, perimeter, maximum/minimum caliper ratio, circularity, and eccentricity were calculated; the Kruskall-Wallis test was used for groupwise comparisons.

The researchers analyzed 4215, 1384, and 1261 basal cell nuclei from the EoE, GERD, and control groups, respectively. They found that the basal cell nuclear maximum/minimum caliper ratio was significantly higher in the EoE group compared with GERD and controls (both P <.001); patients with GERD also had a greater maximum/minimum caliper ratio than controls (P <.01).

Basal cell nuclei in the EoE group had greater eccentricity when compared with GERD and controls (both P <.001); additionally, patients with GERD had greater eccentricity than controls (P <.05).

Basal cell nuclear circularity in the EoE group was decreased when compared with GERD and controls (both P <.001). Basal cell nuclear area was also decreased in controls when compared with the EoE and GERD groups (both P <.001); however, nuclear area was increased in the GERD group when compared with EoE (P <.01). Finally, in controls, basal cell nuclear perimeter was significantly lower than in the EoE and GERD groups (both P <.001).

“Future studies with larger sample size are warranted to validate our findings,” concluded the investigators.


Hiremath G, Correa H, Choksi Y. Esophageal basal cell nuclear dimensions may differentiate eosinophilic esophagitis from gastroesophageal reflux disease in children. Presented at: ACG 2021 Annual Meeting; October 22-27, 2021; Las Vegas, NV and virtual. Poster P0873.