S502 Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

Abstract

Introduction: Differences in EoE presentation or treatment response by ethnic or racial minority status remains understudied. We aimed to determine whether EoE patients of Hispanic/Latinx ethnicity or non-white race have differences in presentation at diagnosis or response to topical corticosteroid (tCS) treatment. Methods: We conducted a retrospective cohort study of the UNC EoE Clinicopathologic database with subjects of any age with a new diagnosis of EoE. Ethnicity and race were recorded as documented in the chart. For the subset who had treatment with a tCS and a follow-up endoscopy/biopsy, we assessed histologic response (< 15 eosinophils/hpf), global symptom response, endoscopic response, EREFS, and an endoscopic severity score (ESS). Hispanic EoE patients were compared to non-Hispanics at baseline, and before and after treatment. The same analyses were repeated for white vs non-whites. Results: Of 1026 EoE patients with ethnicity data, 23 (2%) were Hispanic and most clinical features at presentation were similar to non-Hispanic EoE patients. Out of 466 patients who received tCS, 8 were Hispanic and had numerically higher eosinophil counts (47.0 vs 24.5; p=0.09) and numerically lower histologic response (38% vs 57%; p=0.27) post-treatment. When comparing EoE patients in terms of race, non-white patients (13%) had many differences in presentation: younger age at diagnosis, less insurance, shorter symptom duration, more vomiting, less dysphagia and food impaction, fewer typical endoscopic features, and less dilation. On multivariate analyses, age, vomiting, and furrows remained independently associated with non-white race. Of 475 patients with race data treated with tCS, the 49 non-whites had a significantly lower histologic response rate (41% vs 59%; p=0.01) (Table). After controlling for age, insurance, symptom length prior to diagnosis, total steroid dose, and whether dilation was performed, non-whites were less than half as likely to have histologic response (aOR 0.42, 95%CI: 0.21-0.83). Conclusion: Only 2% of EoE patients at our center were Hispanic, and they had similar clinical presentations as non-Hispanics. While treatment response was lower, this assessment was limited by a small sample size. The non-white EoE group was larger (13%), and presentation was less dysphagia-specific. Non-white patients also had a lower histologic response to tCS which persisted after accounting for differences in presentation.