Abstract

Purpose: The etiology of eosinophilic esophagitis (EoE) is unknown, though allergens may play a pathogenic role. The purpose of this study was to examine seasonal variation in diagnosis of EoE as compared to gastroesophageal reflux disease (GERD). We hypothesized that EoE would be more frequently diagnosed at times of high allergen burden (spring/summer) and there would be no seasonal variation in GERD diagnosis. Methods: We performed a retrospective study of the University of North Carolina EoE clinicopathologic database which contains information on patients with esophageal eosinophilia from 2000–2007. Cases of EoE were defined as having ≥15 eosinophils per high-powered field (0.23 mm2; eos/hpf) with at least one typical symptom (eg dysphagia, heartburn, or feeding intolerance) and with other causes of esophageal eosinophilia excluded. Incident cases were categorized by their esophageal biopsy date. Controls were patients with GERD who also underwent endoscopy and biopsy over this time course. Cases of EoE and GERD were stratified by season and month of diagnosis and compared with chi-square. Results: 149 cases of EoE were identified (mean age 24.5 yrs; range: 8 mos-77 yrs); 72 were 18 years or older (48%), 105 (70%) were male, and 119 (80%) Caucasian. 684 GERD controls were identified (mean age 44.1 yrs; range: 4 mos–87 yrs); 49% were male and 81% Caucasian. 19% of EoE cases were diagnosed in the winter (Dec–Feb), 19% in the spring (Mar–May), 34% in the summer (June-Aug), and 28% in the fall (Sept-Nov; see Figure) compared with 23%, 29%, 23%, and 25% of the GERD cases, respectively (P= 0.01). The highest proportion of EoE cases was diagnosed in August (14%) compared with 7% of GERD cases (P= 0.04). Tissue eosinophil counts were also highest during the summer (77 eos/hpf) compared with winter (57 eos/hpf), with a peak level in August (95 eos/hpf). There was no difference in EoE diagnosis based on age, atopic disease, food allergy, or asthma.FigureConclusion: There is evidence of seasonal variation in the diagnosis of EoE at our center, but not in the diagnosis of GERD. The highest percentage of cases of EoE are diagnosed over the summer, which was also the time of highest tissue eosinophil counts. These findings may help generate hypotheses about environmental etiologies of EoE.

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