Su1848 Differences in Presentation of Eosinophilic Esophagitis by Atopic Status, Eosinophilia, and Age of Symptom Onset: An Analysis of Non-Endoscopic Phenotypes

Abstract

Background: Separate phenotypes of eosinophilic esophagitis (EoE) based on an inflammatory, fibrotic, or mixed appearance have recently been described, but the trends in these phenotypes over time is unknown. Aim: To describe the number of EoE patients with inflammatory, fibrostenotic, and mixed phenotypes over the past decade, determine time trends, and explore reasons for any change. Methods: This was a retrospective study of the University of North Carolina EoE Clinicopathologic database over the past decade, from 2001-2011. Subjects with an incident diagnosis of EoE who met consensus guidelines were included. All had symptoms of esophageal dysfunction, ≥15 eos/hpf (hpf area=0.24 mm2), and did not respond to a PPI trial. The phenotypes were defined as fibrostenotic if there were esophageal rings, narrowing, or strictures and no evidence of linear furrows or white plaques; as inflammatory if there were furrows, plaques, or a normal esophagus and no evidence of fibrostenotic changes; and as mixed if there were a combination of findings. The proportions of phenotypes per year were calculated. Results: Of 374 EoE cases (mean age 25, range 6 mos-82 yrs; 73% male; 81% white; mean eosinophil count 86, range 15609), 134 (36%) had an inflammatory phenotype, 163 (43%) were mixed, and 77 (21%) were fibrostenotic. There was a significant change in the proportion of phenotypes over time (Figure). In 2001, 50% of patients were fibrostenotic, 50% were inflammatory, and none were mixed. In 2011, just 12% were fibrostenotic with 29% inflammatory and 59% mixed (p=0.002). There was no significant change in duration of symptoms prior to the diagnosis of EoE over this time frame (mean 8 yrs in 2001, 6 years in 2006, and 10 years in 2011; p=0.15). The proportion of patients with a endoscopically normal appearing esophagus decreased over this time frame (50% normal in 2001-2002, 16% normal in 2006, and 10% normal in 2001; p=0.05). The age at diagnosis of EoE did not change substantially between 2006 and 2011 (mean 27.7 vs 27.6 yrs; p=0.36). Conclusions: Over the past decade, the proportion of patients with a purely fibrostenotic phenotype of EoE has significantly decreased. This trend does not appear to be explained by a decrease in the length of symptoms prior to diagnosis of EoE or with EoE diagnosed in younger patients. It may be due to increased awareness of the endoscopic findings of EoE and recognition of subtle furrows and plaques with higher resolution endoscopes.