Demographic, Clinical, and Pathologic Characteristics of Eosinophilic Esophagitis Utilizing a National Pathology Database

Abstract

Purpose: Reports on Eosinophilic Esophagitis (EE) are limited to small series of patients from single institutions. The goal of this study was to characterize demographic, clinical and pathologic features of EE over a diverse patient population. Methods: Patients diagnosed with EE without other organ involvement were identified utilizing a national pathology database (Pathology Partners Inc., Irving, TX) from January 2002 to May 2006. EE was defined by: 1) a mean of ≥20 eosinophils in 5 HPF, or 2) when 5 HPF were not available, a mean of ≥30 eosinophils in 2–4 HPF. Eosinophils were not counted beyond 100 per HPF. Demographic and clinical information was provided by the endoscopist. Results: 363 cases met the inclusion criteria (308 by criteria #1, 55 by #2). Patients were identified from 26 states, from a database receiving pathology specimens from 34 states. Male gender predominated 3:1, 270 males (74.4%) to 93 females (25.6%). Ages ranged from 14 months to 98 years, with 42 children (0–17 years), and 321 adults: 78 (21.5%) age 18–29, 84 (23.1%) age 30–39, 88 (24.2%) age 40–49, 32 (8.8%) age 50–59, 25 (6.9%) age 60–69, and 14 (3.9%) age 70 or greater. Dysphagia was present in 65.0% of patients, followed by GERD/heartburn (28.4%), and abdominal pain/dyspepsia (15.2%). In adults, the most commonly reported indications were dysphagia (70.1%), GERD/heartburn (27.1%), and abdominal pain/dyspepsia (13.1%) whereas children reported GERD/heartburn (38.1%), abdominal pain/dyspepsia (31.0%) followed by dysphagia (26.2%). Across adult age groups, the prevalence of dysphagia and GERD/heartburn symptoms ranged from 44–79%, and 16–43%, respectively. The mean eosinophil count per HPF was 57.5 in children and 65.3 in adults. The count ranged from 53.6 in the 70 year plus bracket to 71.2 in the 18–29 year olds. Over the study time period, EE was diagnosed in 0.1% (1/726) of all patients with dysphagia who had upper endoscopy with esophageal biopsy in 2002, 0.9% (20/2226) in 2003, 1.2% (43/3621) in 2004, and 1.9% (110/5892) in 2005. Conclusions: 1. EE is a national disease. 2. EE can be found in any age group but more commonly in men. 3. Dysphagia is the predominant symptom in most adults followed by GERD symptoms. 4. The degree of eosinophilic infiltration remains high throughout all age ranges. 5. The prevalence and/or recognition of EE is increasing markedly in this country.