{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:36:36Z","timestamp":1771374996973,"version":"3.50.1"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2002In the North Denmark Region (580\u2005272 inhabitants), only 0\u20134 cases of possible eosinophilic esophagitis (EoE) were identified annually in 1999\u20132010, suggesting underdiagnosis. This study aimed to increase the diagnosis of EoE by introducing a regional biopsy protocol for patients with dysphagia.<\/jats:p><jats:p>\n          Methods\u2002In 2011, leaders of regional endoscopy units attended a consensus meeting where a biopsy protocol was proposed. The national pathology registry was used to identify patients with esophageal eosinophilic inflammation during 2007\u20132017.<\/jats:p><jats:p>\n          Results\u2002Discussion resulted in consensus on a protocol to take eight biopsy samples in dysphagia patients (four biopsies from 4\u200acm and 14\u200acm above the esophagogastric junction\u2013\u201c4\u201314\u20134 rule\u201d) regardless of the macroscopic appearance, and to code eosinophilia systematically in the pathology registry. A pictogram showing the 4\u201314\u20134 rule was sent to all endoscopy units. The number of patients with esophageal eosinophilia detected per year increased 50-fold after the protocol was implemented in 2011 (median of 1 [interquartile range 0\u20133] vs. 52 [47\u201356]; P\u200a&lt;\u200a0.001), and the number of biopsy samples per patient doubled (median 4 [4\u20135] vs. 8 [6\u20139]; P\u200a&lt;\u200a0.04). Of 309 patients diagnosed with esophageal eosinophilia in 2007\u20132017, 24\u200a% had erosive esophagitis or Barrett\u2019s esophagus, and 74\u200a% had EoE.<\/jats:p><jats:p>\n          Conclusions\u2002A consensus-based biopsy protocol and improved coding of eosinophilia in the pathology registry resulted in a 50-fold increase in patients diagnosed with esophageal eosinophilia\/year. These patients can now receive treatment. The effort to establish the protocol and change the culture of endoscopists and pathologists was minimal.<\/jats:p>","DOI":"10.1055\/a-1206-0852","type":"journal-article","created":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T22:42:44Z","timestamp":1596667364000},"page":"15-24","source":"Crossref","is-referenced-by-count":22,"title":["Implementation of a biopsy protocol to improve detection of esophageal eosinophilia: a Danish registry-based study"],"prefix":"10.1055","volume":"53","author":[{"given":"Anne Lund","family":"Krarup","sequence":"additional","affiliation":[{"name":"Department of Neurogastroenterological Research, Department of Medicine and Centre for Clinical Research, North Denmark Regional Hospital, Hj\u00f8rring, Denmark"},{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asbj\u00f8rn Mohr","family":"Drewes","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"},{"name":"MechSense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per","family":"Ejstrud","sequence":"additional","affiliation":[{"name":"Department of Surgery, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter Thaysen","family":"Laurberg","sequence":"additional","affiliation":[{"name":"Department of Neurogastroenterological Research, Department of Medicine and Centre for Clinical Research, North Denmark Regional Hospital, Hj\u00f8rring, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mogens","family":"Vyberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"},{"name":"Institute of Pathology, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,8,5]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1053\/j.gastro.2017.06.067","article-title":"Epidemiology and natural history of eosinophilic esophagitis","volume":"154","author":"E S Dellon","year":"2018","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/apt.13129","article-title":"The increasing incidence and prevalence of eosinophilic oesophagitis outpaces changes in endoscopic and biopsy practice: national population-based estimates from Denmark","volume":"41","author":"E S Dellon","year":"2015","journal-title":"Aliment Pharmacol Ther"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/j.jaci.2011.09.013","article-title":"Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland","volume":"128","author":"P Hruz","year":"2011","journal-title":"J Allergy Clin Immunol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1111\/all.12733","article-title":"Escalating incidence of eosinophilic esophagitis in Canton of Vaud, Switzerland, 1993\u20132013: a population-based study","volume":"70","author":"B Giriens","year":"2015","journal-title":"Allergy"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/nmo.12009","article-title":"Rapidly increasing incidence of eosinophilic esophagitis in a large cohort","volume":"25","author":"B D van Rhijn","year":"2013","journal-title":"Neurogastroenterol Motil"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.giec.2017.07.001","article-title":"Eosinophilic esophagitis: incidence and prevalence","volume":"28","author":"F J Moawad","year":"2018","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.gie.2006.04.037","article-title":"Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis","volume":"64","author":"N Gonsalves","year":"2006","journal-title":"Gastrointest Endosc"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s00535-019-01624-3","article-title":"Clinical relevance of esophageal subepithelial activity in eosinophilic esophagitis","volume":"55","author":"I Hirano","year":"2020","journal-title":"J Gastroenterol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1053\/j.gastro.2017.05.066","article-title":"Diagnosis and treatment of eosinophilic esophagitis","volume":"154","author":"A Straumann","year":"2018","journal-title":"Gastroenterology"},{"key":"ref10","first-page":"163","article-title":"Epidemiology","volume":"301","author":"L Frank","year":"2003","journal-title":"The epidemiologist\u2019s dream: Denmark. 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