The nature of the involvement of esophageal tissue in eosinophilic esophagitis (EoE) is unclear. We estimated the intra-biopsy site agreements of the histologic scoring system (EoEHSS) scores for the grade (degree) and stage (extent) of involvement of the esophageal epithelial and lamina propria and examined if the EoE activity status influenced the intra-biopsy site agreement.
Demographic, clinical, and EoEHSS scores collected as part of the prospective OMEGA (Outcome Measures for Eosinophilic Gastrointestinal Diseases Across Ages) study were analyzed. Weighted Cohen’s kappa agreement coefficient (k) was used to calculate the pairwise agreements for proximal:distal, proximal:mid, and mid:distal esophageal biopsy sites, separately for grade and stage scores, for each of the eight components of EoEHSS. k of > 0.75 was considered uniform involvement. Inactive EoE was defined as <15 eosinophils per high-powered field.
EoEHSS scores from 1263 esophageal biopsies were analyzed. The k for the stage of involvement of the dilated intercellular spaces (DIS) across all three sites in inactive EoE was consistently > 0.75 (range: 0.87-0.99). The k for lamina propria fibrosis was > 0.75 across some of the biopsy sites but not across all three. Otherwise, the k for all other features, for both grade and stage, irrespective of the disease activity status, was ≤ 0.75 (range: 0.00-0.74).
Except for the extent of involvement of DIS in inactive EoE, the remaining epithelial features and lamina propria are unevenly involved across biopsy sites in EoE, irrespective of the disease activity status. This study enhances our understanding of the effects of EoE on esophageal tissue pathology.

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