Su1147 Prevalence of Eosinophilic Esophagitis in African Americans and Hispanics Presenting With Dysphagia: A Single Center Retrospective Analysis

Abstract

Background: Current guidelines indicate obtaining tissue to evaluate for eosinophilic esophagitis (EoE) as an option in patients with dysphagia who receive upper endoscopy evaluation without obvious cause for their complaint. However, the utility of this practice is unclear. The primary aim of the study was to determine the diagnostic yield of pathologic evaluation for EoE in patients with normal and abnormal findings on upper gastrointestinal endoscopy at the University of Oklahoma Health Sciences Center (OUHSC). Methods: All cases with a primary indication of dysphagia from January 2006 to November 2011 were retrospectively identified using the OUHSC electronic endoscopy database. Patients who had endoscopic biopsies for pathologic evaluation of EoE during their procedure were included for analysis. The pathologic reports and endoscopic findings were independently reviewed by different physicians who were not aware of the other results, then correlated by a third investigator to determine diagnostic yield rates for patients with and without endoscopic findings suggestive of EoE. Results: A total of 3,448 upper gastrointestinal endoscopies were performed at OUHSC during the study period. 547 procedures from 527 patients, age 18 to 90, met entry criteria and were analyzed. Review of these exams revealed 284/547 (52%) with a normal upper gastrointestinal endoscopy, 85/547 (16%) with features suggestive of EoE (furrowing or longitudinal rings), 73/547 (13%) with esophagitis, 45/547 (8%) with lower esophageal strictures or Schatzki ring, and 60/547 (11%) with other findings. Pathologic review indicated 303/547 (55%) with esophagitis, 207/547 (38%) with normal mucosa, and 37/547 (7%) with EoE. Among the 37 patients diagnosed with EoE, endoscopy revealed 23 (62%) with features of EoE, 7 (19%) with normal exam, and 7 (19%) with esophageal stenosis or esophagitis. The overall pathologic yield of EoE to endoscopic findings was 23/ 85 (27%) with features suggestive of EoE, 7/284 (2%) with normal exam, and 7/178 (4%) with all other findings. Conclusions: Endoscopic biopsies for pathologic evaluation of EoE often yield positive results in patients with endoscopic features suggestive of EoE. However, the yield of biopsies in those without endoscopic features suggestive of EoE is very low and is unlikely to alter patient management with increased cost.