Incidence Of Eosinophilic Esophagitis Research Articles

Rising trend in p​ediatric eosinophilic esophagitis incidence in Spain: Results of a prospective study 2014-16.

The rate of eosinophilic esophagitis (EoE) diagnosis is increasing. This study aims to determine the incidence of EoE in the pediatric population residing in the southwestern Madrid and to analyze whether absolute monthly pollen counts, modified or not by the principal atmospheric pollutants, are associated with it. A cross-sectional study on prospectively recruited patients was designed to calculate the incidence of EoE in children aged under 15years who were diagnosed between September 2014 and August 2016 in twelve hospitals. We collected demographic and symptoms data, date of onset of symptoms, date of medical consultation, and date of endoscopic diagnosis of each included patient. Relative risk estimation was performed to assess the association between the incidence of diagnosis and monthly pollen counts and levels of atmospheric pollutants. All these models were adjusted for the number of total patients that underwent endoscopy at first time. One hundred forty-eight patients were included. The most frequent symptoms were abdominal pain [42.57%], dysphagia [42.57%], and impaction [39%-86%]. The median overall monthly incidence was 1.13 [interquartile rank: 0.97-1.43] cases/100,000 children, and the annual mean was 15.2. The overall analysis of the relationship between incidence and absolute monthly counts, corrected for the number of first-time endoscopies performed, revealed no statistically significant association with pollen and air pollutants. There was a higher frequency of diagnosis during the pollination period of Cupressaceae [relative risk 1.647; 95% CI (1.192-2.276) p<.002] and during February and November (relative risk 1.67; p<.01). This study confirms the high incidence of eosinophilic esophagitis and also suggests a period of higher incidence of diagnosis in the months of February and November as well as in the period of high pollination of Cupressaceae.

Emerging incidence trends of eosinophilic esophagitis over 25 years: Results of a nationwide register‐based pathology cohort

RationaleEosinophilic esophagitis (EoE) has emerged from a case‐reportable illness in the early 1990s to a distinct clinicopathological entity. Increasing worldwide incidences have been observed, although due to various study designs estimates are inconsistent.AimTo determine population‐based annual incidence rates over a time period of 25 years.MethodsA nationwide register‐based pathology (PALGA) search was performed to identify reports describing esophageal eosinophilia between 1995 and 2019. EoE was identified if the diagnosis was confirmed by the pathologist. Crude incidence rates were estimated by the number of new EoE cases per year and matched with population data.ResultsBetween 1995 and 2019, 7361 unique patients’ reports mentioned esophageal eosinophilia, of these 4061 were classified as EoE (71% male, mean age 37.9 ± 18.4 years). In total, 639 (16%) children (<18 years) were diagnosed. The EoE incidence increased from 0.01 in 1995 (95% CI: 0.0 – 0.04) to 3.16 (95% CI: 2.90 – 3.44) per 100.000 inhabitants in 2019. EoE was significantly more prevalent in males (OR 2.48 | 95% CI: 2.32 – 2.65; vs. females p < 0.001) and adults (OR 1.42 | 95% CI: 1.31 – 1.55; vs. children p < 0.001). Highest incidences were observed in 2019, being 4.37 (95% CI: 3.94 – 4.84) vs. 1.97 (95% CI: 1.68 – 2.29) per 100.000 males and females, respectively (p < 0.001). No seasonal variation was observed.ConclusionOver the past quarter century, the annual rates of newly diagnosed EoE patients raised dramatically and this increase has not reached a deceleration yet.

Reversibility of Endoscopic Features after Treatment for Eosinophilic Esophagitis.

PurposeThe prevalence and incidence of eosinophilic esophagitis (EoE) are increasing worldwide. Despite increased understanding of inflammatory pathogenesis, changes in endoscopic features after treatment of EoE have not been clearly described. We aimed to investigate the reversibility of endoscopic features of EoE after treatment.Materials and MethodsOut of 58 adult subjects who were diagnosed with EoE at the Yonsei University Health System from July 2006 to August 2019, we recruited 33 subjects (30 males; mean age: 42 years) whose pre-treatment and post-treatment endoscopic images were available. Endoscopic features included both inflammatory and fibrostenotic features. Exudate, edema, furrow, and crepe paper-like mucosa were classified as inflammatory features. Ring and stricture were classified as fibrostenotic features. We compared changes in endoscopic features after treatment for EoE.ResultsAfter treatment, clinical symptoms improved in all patients. The following endoscopic features were observed before treatment: furrow (81.8%), edema (90.9%), exudate (42.4%), ring (27.3%), crepe paper-like mucosa (15.2%), and stricture (3.0%). Endoscopic remission was achieved in 21 patients (63.6%). Inflammatory features were reversible (72.7%, p<0.001), whereas fibrostenotic features were not (10%, p=0.160). Exudate had resolved in 92.9% of patients, edema in 70% and furrow in 88.9%. Ring and stricture persisted in almost all of the patients (9/10) who had these endoscopic features before treatment.ConclusionWe outlined the reversibility of endoscopic inflammatory features of EoE. Fibrostenotic features were irreversible after esophageal remodeling in patients with EoE. However, further validation studies with long-term follow-up are needed.

Eosinophilic esophagitis: clinical, endoscopic, histologic and therapeutic differences and similarities between children and adults.

In the absence of secondary causes, eosinophilic esophagitis (EoE) is a chronic, local, progressive, T-helper type 2 immune-mediated disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. In the last 20 years, the incidence and prevalence of EoE have risen sharply, and the chances of encountering affected patients in clinics and endoscopy rooms have increased. Nevertheless, it is estimated that the mean diagnostic delay of EoE is 4–6 years in both children and adults. Unfortunately, the longer the disease stays unrecognized, the likelier it is for the patient to have persistent or increased esophageal eosinophilic inflammation, to complain of non-resolving symptoms, and to develop fibrotic complications. Early detection depends on the recognition of initial clinical manifestations that vary from childhood to adulthood and even among patients of the same age. The disease phenotype also influences therapeutic approaches that include drugs, dietary interventions, and esophageal dilation. We have herein reviewed epidemiologic, clinical, endoscopic, and histologic features and therapeutic options of EoE focusing on differences and similarities between children and adults that may certainly serve in daily clinical practice.

Eosinophilic esophagitis: definition, epidemiology and quality of life

Eosinophilic esophagitis (EoE) is a clinicopathological disease defined by symptoms of esophageal dysfunction and ≥15 eosinophils/HPF after excluding other causes of esophageal eosinophilia. Increasing attention has been paid by clinicians and researchers after its first description in 1978. Many consensuses and guidelines have been issued over the years, as gastroenterologists did not reach an agreement on EoE definition, especially regarding the controversial responsiveness to proton pump inhibitor (PPI) therapy. Of note, recent evidence suggests that the incidence and prevalence of EoE have been increasing through the years: many risk factors have been advocated as possible reasons for this, although further studies are needed. In this brief review, we will first cover the history of EoE in the literature, with a focus on its varying definition throughout the years. Then, we will discuss EoE epidemiology, emphasizing potential risk factors explaining its increasing incidence and prevalence. Last, we will deal with the quality of life of adult and pediatric patients with EoE.

Eosinophilic esophagitis: definition, epidemiology and quality of life

Eosinophilic esophagitis (EoE) is a clinicopathological disease defined by symptoms of esophageal dysfunction and ≥15 eosinophils/HPF after excluding other causes of esophageal eosinophilia. Increasing attention has been paid by clinicians and researchers after its first description in 1978. Many consensuses and guidelines have been issued over the years, as gastroenterologists did not reach an agreement on EoE definition, especially regarding the controversial responsiveness to proton pump inhibitor (PPI) therapy. Of note, recent evidence suggests that the incidence and prevalence of EoE have been increasing through the years: many risk factors have been advocated as possible reasons for this, although further studies are needed. In this brief review, we will first cover the history of EoE in the literature, with a focus on its varying definition throughout the years. Then, we will discuss EoE epidemiology, emphasizing potential risk factors explaining its increasing incidence and prevalence. Last, we will deal with the quality of life of adult and pediatric patients with EoE.

S0415 Eosinophilic Esophagitis in the United States from 2009-2015: Cross-Sectional Analysis of Office Visits From the National Ambulatory Medical Care Survey

INTRODUCTION: Histologically, Eosinophilic Esophagitis (EoE) is defined by an accumulation of eosinophils in the mucosal lining of the esophagus. Leading symptoms are dysphagia, chest pain, and heartburn. Most cases occur in younger, non-Hispanic white males and co-occurrence with asthma is frequent. The incidence of EoE has increased over the last twenty years, partly due to increased recognition. To date, data on EoE is mostly limited to regional demographic studies. Our aim was to conduct a cross-sectional study examining demographics, comorbidities, and medication use of EoE patients in the United States (US) from 2009-2015. METHODS: The CDC’s National Ambulatory Medical Care Survey (NAMCS) uses weighted sampling methods to generate cross-sectional data representative of ambulatory care visits in the US. Using ICD-9 codes, we identified patients with EoE for the period 2009-2015. For these patients, we used visit codes to identify the following: presence of GERD, dysphagia, and asthma. Drug codes were used to investigate PPI and topical steroid use. Weighting of encounters using SPSS were performed to provide population estimates. RESULTS: After weighting, the study group included 710,339 unique outpatient visits for EoE; 63.9% male, mean age 35.5 years. Using corresponding estimated census data for 2013, the year with the greatest number of EoE visits, 70.1/100,000 outpatient visits in the US were for EoE. Race/ethnicity: non-Hispanic white 79.1% (6% higher than general population for 2013); NHB 18.5%; Hispanic 1.7%. Mean BMI was 25.3 ± 5.2 with 23.4% of patients having a BMI >30. Overall, 21.0% of patients had concomitant asthma. Among presenting complaints for an office visit, there were 29.0% with GERD, 15.0% with dysphagia, and 19.8% with an “allergy disorder”. Most patients were on PPI therapy (55.4%) and 29.4% were on topical steroids. CONCLUSION: Our nationwide data confirms that EoE affects younger adults, males, and the non-Hispanic white race out of proportion to the general population. About 1 in 5 EoE patients have asthma which is roughly 3 times higher than the general population supporting the association. GERD was the presenting complaint for nearly twice as many visits compared to dysphagia, a unique finding compared to previous studies. Most patients were on a PPI and nearly one-third were on topical steroids. Additional large scale, unbiased, population-based studies are needed to provide epidemiologic clarity concerning EoE.

S0710 Epidemiology of Eosinophilic Esophagitis in Inflammatory Bowel Disease and General Population: A Population-Based Study

INTRODUCTION: Some chronic immune-mediated diseases like Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) have similar pathogenesis. Recent studies have shown that both the prevalence and incidence of EoE and IBD are rising in developed countries. However, only few case reports on concurrent EoE and IBD were published and only limited data is available describing the epidemiology. Our objective was to evaluate the prevalence and associated comorbidities of concurrent EoE and IBD. METHODS: We performed a population-based study using IBM EXPLORYS, a HIPPA-enabled web platform that includes over 65 million patient data, pooled from multiple healthcare systems with distinct electronic health records. The prevalence of EoE in patients with IBD and in general population without IBD was compared. The IBD patient group was further stratified into Crohn's disease and Ulcerative colitis groups. Prevalence was calculated per 100,000 patients. Patient characteristics like age, gender and co-morbid immune-mediated disorders like celiac disease, asthma, and eczema were compared between patients with and without EoE in Crohn's disease, UC and the general population. Data were analyzed with R statistical software (RStudio, Inc. Boston, MA). RESULTS: A total of 197,050 patients with IBD and 64,095,520 without IBD were identified. Among the 197,050 cohorts with IBD, 100,780 (51%) had CD and 96,270 (49%) had UC. EoE prevalence is significantly higher in the IBD group compared to the general population (533 vs. 47, P < 0.0001). There was a significant difference in the prevalence of EoE between Crohn's disease and UC group (575 vs. 488, P = 0.008). The proportion of patients between age 18–65 years was significantly higher in EoE all 3 groups. A significant association of asthma and eczema with EoE was noted in all three groups. CONCLUSION: The risk of EoE is significantly higher among IBD patients, both Crohn's disease and UC. Concurrent diagnoses of EoE and IBD might modify the risk of IBD- and EoE-related complications. Studies to evaluate the mechanisms underlying the observation are needed.Table 1.: Prevalence and characteristics of patients with Eosinophilic esophagitis (EoE) associated with Crohn's disease, Ulcerative colitis and in general population

S0429 Is Rise in Incidence of Eosinophilic Esophagitis as a Result of Increased Awareness? A 15-Year Study Population-Based Study in Calgary, Canada

S0429 Is Rise in Incidence of Eosinophilic Esophagitis as a Result of Increased Awareness? A 15-Year Study Population-Based Study in Calgary, Canada

Management of Eosinophilic Esophagitis: Dietary and Nondietary Approaches

Eosinophilic esophagitis (EoE) is an allergen-driven chronic inflammatory condition, characterized by symptoms related to esophageal dysfunction and confirmed histologically by esophageal mucosal eosinophilia. Since its first description in the 1990s, the incidence and prevalence of EoE have been on the rise. It is known to affect all ages of various ethnic backgrounds and both sexes; however, it is most seen in White males. Children with EoE often present with abdominal pain, nausea, vomiting, and failure to thrive, whereas adults with EoE typically present with dysphagia and food impaction. Diagnosis of EoE requires histologic confirmation of elevated esophageal eosinophils in a symptomatic patient, and only after secondary causes have been excluded. Because EoE is a chronic and progressively fibrostenotic disease, treatment goals include resolution of symptoms, induction and maintenance of disease remission, and prevention and possibly reversal of fibrostenotic complications, while minimizing treatment-related adverse effects and improving quality of life. Treatment strategies include the "3 D's"-drugs, diet, and dilation. Standard drug therapies include proton-pump inhibitors and topical corticosteroids. Dietary therapies include elemental diet, allergy testing-directed elimination diet, and empiric elimination diets. Endoscopic esophageal dilation for EoE strictures can alleviate esophageal symptoms but has no effect on mucosal inflammation. Recent progress in EoE research has made possible evidence-based clinical guidelines. Ongoing pharmacologic trials show promise for novel biologic agents in the treatment of refractory EoE.

Behavioral issues and quality of life in children with eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a chronic disease characterized by symptoms related to esophageal dysfunction and eosinophil-predominant inflammation (≥15 eosinophils/high power field). In the last ten years, several epidemiological studies showed a significant increase in the incidence and prevalence of EoE, especially in children in Western Countries. Although EoE often presents with gastrointestinal symptoms, adults and children may develop extraintestinal symptoms and behavioral issues. Also, the chronic nature of the disease, long-term therapies, and strict follow-up may impair the quality of life of patients and their family. This review summarizes current knowledge on the behavioral and psychosocial issues and quality of life of children and adolescents with EoE and their caregivers.

Eosinophilic gastroenteritis: epidemiology, diagnosis, and treatment.

Although several reviews concerning diagnosis and treatment of eosinophilic esophagitis (EoE) have been presented, there are few in regard to eosinophilic gastroenteritis (EGE). Fortunately, findings related to epidemiology, as well as diagnosis and treatment of this disease have recently been increasing. The rates of incidence of both EoE and EGE have been reported to be increasing. For accurate diagnosis, plasma concentrations of thymic stromal lymphopoietin and IL-33 may be useful as biomarkers, though consensus has not been reached, while increased eosinophil infiltration in gastrointestinal tissue remains a critical factor. Topical glucocorticoid administration, an elimination diet, and molecular target therapy with neutralizing antibodies are potentially effective therapies that have recently been evaluated. As seen with other allergic diseases, EGE seems to be increasing. Several research projects regarding diagnosis and treatment of the disease are currently in progress.

Early Life Risk Factors in Pediatric EoE: Could We Prevent This Modern Disease?

Eosinophilic esophagitis (EoE) is a chronic antigen-mediated inflammatory disease that affects the esophagus. In the last 20 years, a large number of epidemiological studies showed a significant increase in the incidence and prevalence of EoE, especially in developed countries. This phenomenon might correlate to the overall increase in pediatric allergic diseases or might be a result of improved medical awareness and knowledge through modern diagnostic instruments. Since 1993, when EoE was first recognized as a distinct clinical entity, several signs of progress in the pathophysiology of EoE were achieved. However, a few studies reported data on early risk factors for pediatric EoE and how these factors may interfere with genes. Currently, the most defined risk factors for EoE are male sex, Caucasian race, and atopic comorbidities. Other putative risk factors may include alterations in epithelial barrier function and fibrous remodeling, esophageal dysbiosis, variation in the nature and timing of oral antigen exposure, and early prescription of proton pump inhibitors and antibiotics. Notably, the timing and nature of food antigen exposure may be fundamental in inducing or reversing immune tolerance, but no studies are reported. This review summarized the current evidence on the risk factors that might contribute to the increasing development of EoE, focusing on the possible preventive role of early interventions.

Orodispersible budesonide tablets for the treatment of eosinophilic esophagitis: a review of the latest evidence.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. The incidence of EoE has increased substantially over the past two decades in Europe and North America. The natural course of EoE appears to be progressive with a high risk of stricture formation. The current European guideline recommend swallowed topical corticosteroids, proton-pump inhibitors or dietary intervention for initial and long-term treatment of EoE. Swallowed topical corticosteroids can be considered to be the best studied drug class in EoE, with more than 1000 patients enrolled in randomized clinical trials worldwide. In most of them, fluticasone or budesonide formulations have been used that were originally designed for asthma therapy, thus presumably suboptimal for EoE treatment. The new orodispersible budesonide tablet with effervescent properties is the first approved esophageal-targeted formulation specifically developed for the treatment of EoE, which has become available in many European countries. This article gives an overview of the evolution of topical corticosteroids in EoE and provides an update on recent data from large-scale multicenter trials exploring the efficacy and safety of the orodispersible budesonide tablet with effervescent properties in adult EoE patients.

Study on the association between eosinophilic esophagitis and bronchial asthma in Egyptian patients with esophageal symptoms

Introduction Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus in which eosinophils play a major role in its pathogenesis and is presented clinically by esophageal dysfunction. EoE represents the second most common cause of chronic esophageal disease after gastroesophageal reflux disease (GERD) and is considered the most common cause of dysphagia in both adults and children. Asthma is a well-known chronic inflammatory disorder of the airways that involves several inflammatory cells including eosinophils. Multiple inflammatory mediators developed the characteristic pathophysiological changes that resulted in airway obstruction and appearance of symptoms of cough and breathlessness. This study aimed to study the incidence of EoE in Egyptian patients with bronchial asthma and address the patient’s characters and risk factors that increases the association. Settings and design This study was carried out on Egyptian asthmatic patients with esophageal symptoms. From 200 asthmatic patients, only 89 patients had esophageal symptoms (heartburn, regurgitation, or dysphagia) and were prepared for endoscopy. Patients and methods Upper gastrointestinal tract endoscopy was performed on all 89 cases and the findings were reported. Esophageal biopsy was taken from all cases and examined histopathologically for EoE criteria. Results The results showed that about 11% of asthmatic patients who suffered from GERD symptoms had associated EoE confirmed by esophageal biopsy and histologic findings. The incidence of EoE was increased in atopic asthmatic patients who had high immunoglobulin E. Conclusion Asthmatic patients who suffered from GERD symptoms should be assessed for EoE by endoscopic and histopathological examination.

Nationwide Multicenter Study of Eosinophilic Esophagitis in Korean Children.

PurposeIn East Asian countries, there are only a few epidemiologic studies of eosinophilic esophagitis (EoE) and no studies in children. We investigated the incidence and compared the clinical characteristics of EoE and eosinophilic gastroenteritis involving the esophagus (EGEIE) in Korean children.MethodsA total of 910 children, who had symptoms of esophageal dysfunction, from 10 hospitals in Korea were included. EoE was diagnosed according to diagnostic guidelines and EGEIE was diagnosed when there were >15 eosinophils in the esophagus per high power field (HPF) and >20 eosinophils per HPF deposited in the stomach and duodenum with abnormal endoscopic findings.ResultsOf the 910 subjects, 14 (1.5%) were diagnosed with EoE and 12 (1.3%) were diagnosed with EGEIE. Vomiting was the most common symptom in 57.1% and 66.7% of patients with EoE and EGEIE, respectively. Only diarrhea was significantly different between EoE and EGEIE (p=0.033). In total, 61.5% of patients had allergic diseases. Exudates were the most common endoscopic findings in EoE and there were no esophageal strictures in both groups. The median age of patients with normal endoscopic findings was significantly younger at 3.2 years, compared to the median age of 11.1 years in those with abnormal endoscopic findings (p=0.004).ConclusionThe incidence of EoE in Korean children was lower than that of Western countries, while the incidence of EGEIE was similar to EoE. There were no clinical differences except for diarrhea and no differences in endoscopic findings between EoE and EGEIE.

2860 Safety of Esophageal Dilation in Patients With Eosinophilic Esophagitis in a Single Center Cohort

INTRODUCTION: Eosinophilic esophagitis (EoE), a chronic immune-mediated disorder, is a leading cause of food impaction due to fibrotic formation of rings, narrowing, and strictures. Historically, esophageal dilation (ED) was reserved as second-line therapy for EoE after failure of medical management, due to concern of complications, mainly perforation. Now, ED is recognized as an effective treatment for symptomatic relief. The aim of this study is to assess the safety of ED in a large cohort of EoE cases in a single center. METHODS: A retrospective review of patients with biopsy confirmed EoE at University of Iowa Hospitals and Clinics between the years 2006 – 2018 was conducted. All subjects met diagnostic criteria for EoE; presence of esophageal dysfunction and mucosal eosinophilic infiltration (≥15 eos/hpf). Histologic and clinical features, ED characteristics and related complications, and self-reported symptomatic improvement were extracted via chart review. Descriptive statistic with univariate analysis was performed. RESULTS: A total of 160 patients were dilated 295 times, ranging from 1-12 dilations per patient, with an average of 1.91 dilations per patient. 67 patients (41.88%) required &gt;1 dilation. Procedures were generally tolerated well, with no major bleeds or perforations. The overall complication rate was 6.1%, primarily due to post-procedural chest pain (4.8%). Three patients had sedation related complications: one aspiration pneumonia and two ICU admissions for respiratory distress. Clinical improvement was documented in 87% of dilations on follow up. Table 1 and Figure 1 and 2. CONCLUSION: The prevalence of EoE is increasing with rates of 0.5 – 1 cases per 1000 individuals, with 25-35% of these patients requiring ED for symptomatic management. In the early 2000s, many reports suggested an increased procedure-related risk, including esophageal perforation. Recent systematic review and meta-analysis have shown otherwise. Present published rate of perforation in dilation in EoE occurs in &lt; 0.3% of procedures, which approximates that of dilation for other benign esophageal indications. Our study is consistent with current data. Taking the above safety data of ED into account along with the rising incidence of EoE, lends evidence to the acceptance of ED as a safe and effective treatment. ED should therefore be considered a safe procedure in EoE patients for symptomatic management in addition to dietary and pharmacological interventions.

2873 The Demographic, Clinical, and Endoscopic Features of Patients With Eosinophilic Esophagitis (EOE) in a Rural Gastroenterology Solo Practice in Central Maine

INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic, food-triggered, immune-mediated disorder of the esophagus. The average age of adult diagnosis is 30 years and the M:F ratio is 3:1. Rural patients may be at higher risk of EoE and may present with heartburn rather than dysphagia. This study aimed to characterize the demographic, clinical, and endoscopic features of adult rural EoE patients. METHODS: This was a retrospective, descriptive analysis of data obtained between 2013 and 2018. Adults ≥ 18 years with ≥ 15 eos/HPF regardless of PPI-response were included. The reported incidence of EoE is 7.2/100,000 and the expected sample size was 22. Statistical analysis of demographics, clinical history, and endoscopy data was conducted. RESULTS: During the study period there were 51 cases and the mean age at diagnosis was 45 years. There was no significant difference between the mean age at diagnosis in males and females, 44 vs 45 years. The M:F ratio was 1.8:1. The average BMI was 31.3, 80% were overweight or obese, and 57% were obese. There was no significant difference between the BMI of males and females. The frequency of tobacco use was 41% and cannabis use was 14%. Half (49%) had other atopic conditions, 16% had a family history of atopy, and 2% had a family history of EoE. Fifty-two percent were PPI-responsive and 53% were responsive to PPI or H2-blocker. While 51% of patients presented with dysphagia, females more often presented with dysphagia when compared to males (61% vs 45%; P = 0.0002). Food impaction on presentation was rare and no female patient presented with food impaction (0% vs 9%). Compared to males, more females had rings (72% vs 55%; P &lt; 0.0001) but significantly more males had fibrotic strictures (36% vs 33%; P = 0.04). CONCLUSION: EoE is common in this rural solo GI practice and the incidence was higher than predicted. EoE is more common in males but rural females may be impacted more than urban females. Obesity and tobacco exposure are prevalent features in this population. In contrast to previous study, most rural EoE patients present with dysphagia and not heartburn and dysphagia is more prevalent in females than males. Rings are the most common endoscopic feature however rings are more prevalent in females whereas strictures are more prevalent in males. Rings are likely associated with the symptom of dysphagia but not with the presence of fibrotic strictures. EoE diagnosis is delayed by 15 years in this rural environment emphasizing the need for increased awareness.

Eosinophilic esophagitis during sublingual and oral allergen immunotherapy.

The aim of this review is to discuss the current evidence regarding the development of eosinophilic esophagitis (EoE) in individuals undergoing oral and sublingual immunotherapy (SLIT) for both food and environmental allergens. Cumulative incidence of EoE in patients on allergen immunotherapy for peanut, milk, and egg is estimated. De novo development of EoE in patients undergoing oral and SLIT has been demonstrated on the scale of case reports and prospective randomized trials. However, few individuals with EoE-like symptoms during immunotherapy undergo endoscopy, and the long-term outcomes of immunotherapy-associated EoE are unknown. Evidence exists to suggest that allergen immunotherapy could place individuals at risk for the development of EoE, the true incidence of which may vary depending on antigen exposure and methods used to define the condition.

Pharmacotherapies for the Treatment of Eosinophilic Esophagitis: State of the Art Review.

Eosinophilic esophagitis (EoE), a chronic allergic disorder of the esophagus, is characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. The incidence of EoE has increased substantially over the past two decades, coinciding with the so-called allergy epidemic. Current treatment options consist of dietary intervention, endoscopic dilatation, and pharmacotherapy. Given that EoE is a chronic progressive disease that is prone to relapse after cessation of therapy, these treatment options are suboptimal for long-term management. Persistent, uncontrolled esophageal inflammation is associated with esophageal remodeling and stricture formation, thus, the creation and/or discovery of alternative treatments is of paramount importance. The pathogenesis of EoE is currently under intense investigation, and recent insights concerning cellular and molecular etiology have led to the development of therapies that target specific pathophysiological pathways. This article provides an overview of established EoE pharmacotherapies, which include proton pump inhibitors and swallowed topical steroids. Additionally, anti-allergic targets, immunosuppressives, and monoclonal antibodies (such as mepolizumab, reslizumab, QAX576, RPC4046, dupilumab, omalizumab, and infliximab) that have been evaluated as treatments for EoE are summarized. Finally, several promising therapeutic agents (e.g., sialic acid-binding immunoglobulin-like lectin 8 antibodies, the transforming growth factor-β1 signal blocker losartan, CC chemokine receptor type 3 antagonists, thymic stromal lymphopoietin antibodies, antibodies targeting the α4β7 integrin, anti-interleukin-9 antibodies, and anti-interleukin-15 antibodies) that target specific molecules or cells implicated in the pathogenesis of EoE are proposed.