A Retrospective Analysis of Esophageal Eosinophilia in Patients with Aspirin-exacerbated Respiratory Disease

Abstract

Gastrointestinal symptoms are the most common side effect leading to discontinuation of aspirin therapy in patients with aspirin-exacerbated respiratory disease (AERD). Some patients with gastrointestinal symptoms on high-dose aspirin demonstrated biopsy-proven esophageal eosinophilia (EE). In a large cohort of patients with AERD we report on this novel clinical entity. Charts from 387 patients enrolled in the Brigham and Women’s Hospital AERD registry were reviewed for history of biopsy-proven EE. All subjects were diagnosed with AERD by a Partners Healthcare physician. Data was analyzed using student’s t-test and chi-square tests where appropriate. 13 (3.4%) patients had a history of biopsy-proven EE documented in the medical chart. 10 of 13 were desensitized to aspirin with 9 of them first developing EE 3 months to 6 years after aspirin initiation. AERD subjects with EE demonstrated greater rates of gastric irritation at follow-up visits (p<0.001) and of aspirin discontinuation due to gastric irritation (p=0.013, Pearson’s Chi-Squared test) than the non-EE group. Those with EE reported a faster rate of nasal polyp regrowth compared to the non-EE group (4.75±3.35 versus 14.9±20.8 months, p<.0001). Our study is the first to explore the relationship between aspirin therapy in AERD and the development of EE. We observed that EE develops in subjects with AERD both before and after initiation of daily aspirin therapy with more cases reported after starting aspirin. We found that the presence of EE is associated with faster regrowth of nasal polyps suggesting more severe sino-nasal mucosal pathology in this population.