Prevalence Of Eosinophilic Esophagitis In Patients Research Articles

A Comprehensive Global Population-Based Analysis on the Coexistence of Eosinophilic Esophagitis and Inflammatory Bowel Disease.

We explored inflammatory bowel disease (IBD) and eosinophilic esophagitis (EoE) coexistence using a global dataset. Investigating their epidemiology, risks, and impact, we aimed to enhance the understanding of concurrent diagnoses and patient outcomes. A retrospective population-based cohort study was conducted using deidentified patient data from the TriNetX database (2011-2022). We estimated the incidence and prevalence of EoE in patients with IBD, including both Crohn's disease (CD) and ulcerative colitis (UC), and vice versa. Risks of select immune-mediated conditions and disease complications were compared among patients with EoE, IBD, or concurrent diagnoses. Our results included 174,755 patients with CD; 150,774 patients with UC; and 44,714 patients with EoE. The risk of EoE was significantly higher among patients with CD (prevalence ratio [PR] 11.2) or UC (PR 8.7) compared with individuals without IBD. The risk of IBD was higher in patients with EoE (CD: PR 11.6; UC: PR 9.1) versus those without EoE. A propensity-matched analysis of IBD patients revealed that, when comparing patients with and without EoE, the relative risk of immune-mediated comorbidities was significantly greater for celiac disease, IBD-related inflammatory conditions, eczema and asthma (CD: n = 1896; UC: n = 1231; p < 0.001). Patients with a concurrent diagnosis of EoE and IBD had a higher composite risk of IBD-related complications (CD: adjusted HR (aHR) 1.14, p < 0.005; UC: aHR 1.17, p < 0.01) and lower risk of food bolus impaction (aHR 0.445, p = 0.0011). Simultaneous EoE and IBD increased IBD-related complications risk, needing more treatment (glucocorticoids, biologic therapy, abdominal surgery), while reducing EoE-related issues like food bolus impaction.

Increased Prevalence of Eosinophilic Esophagitis in Patients With Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) and eosinophilic esophagitis (EoE) are immune-mediated inflammatory conditions that share common histopathologic features. Once considered two separate pathologies, preliminary data has suggested that a higher prevalence of EoE may exist in patients with CRS. We aimed to expand the base of evidence across geographic regions and investigate the association between EoE and CRS, including CRS with nasal polyposis (CRSwNP). Quantitative data detailing the prevalence of CRS, CRSwNP, and EoE were pooled from 6 large academic institutions spread across the United States using Epic electronic medical record system. One-way analysis of variance was then used to analyze the data. The mean prevalence of EoE in our general population sample of over 26 million individual records was 0.058% (range, 0.013%-0.103%). The mean prevalence of EoE in our sub-populations of individual with diagnoses of CRS and CRSwNP was 0.43% (F(1,12) = [8.194], P = .01) and 0.84% (F(1,12) = [23.61], P < .01) respectively. This study reveals an 8-fold greater prevalence of concurrent EoE in patients with CRS. Importantly, this is the first study to describe the association of EoE and the CRSwNP subtype, and we demonstrate a 14-fold greater prevalence of EoE in patients with CRSwNP.

Epidemiology of Eosinophilic Esophagitis in Patients with Cystic Fibrosis: A Population-Based 5-Year Study.

PurposeThe prevalence of eosinophilic esophagitis (EoE) has been on the rise since it was first described in the 1990s. Several diseases and exogenous factors have been associated with EoE. Our aim was to investigate the epidemiology of EoE in cystic fibrosis (CF) patients.MethodsWe identified individuals with CF from September 2014 to September 2019 within a database (IBM Explorys Solutions, Inc.). The prevalence of EoE in patients with CF was compared to the general population.ResultsThe database included 36,111,860 patients during the 5-year study period: 12,950 with CF (0.036%) and 28,090 with EoE (0.078%). EoE prevalence was higher in CF patients than the general population (46 in 10,000 vs. 7.8 in 10,000, p<0.001). Patients with CF and EoE were more likely to be male (50% vs. 33.5%, p<0.008), children (33.3% vs. 16.5%, p<0.001), and non-Hispanic (100% vs. 88.7%, p<0.001) than CF patients without EoE. CF with EoE patients were more likely to be children than EoE only (33.3% vs. 10.5%, p<0.001). Allergic conditions were generally more prevalent in CF with EoE than CF only (83.3% vs. 68.3%, p=0.01) and EoE only (83.3% vs. 69.3%, p=0.014).ConclusionEoE is nearly 6-times more prevalent in CF patients. Those patients had higher incidence of other atopic conditions. EoE must be considered in the differential diagnosis of patients with CF presenting with dysphagia, refractory gastroesophageal reflux, vomiting, and other esophagus-related symptoms.

Increased Prevalence of Eosinophilic Esophagitis (EoE) in Children with Inflammatory Bowel Disease (IBD)

Patients with IBD are at increased risk for developing EoE, but little is known about the clinical characteristics or risk factors for developing EoE in this population. The objective of this study was to assess the prevalence of EoE in patients with IBD and compare characteristics between patients with both IBD/EoE and EoE alone.

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

Retrospective Analysis of Eosinophilic Esophagitis in Patients with Refractory Gastroesophageal Reflux Disease.

IntroductionEosinophilic esophagitis (EoE) is not a common differential diagnosis in patients with longstanding refractory gastroesophageal reflux disease (GERD). The aim of this retrospective analysis was to assess the prevalence of EoE in patients with refractory GERD.MethodsThis retrospective analysis was performed in the Gastroenterology Department of a tertiary care institute in Karachi, Pakistan. Records of esophagogastroduodenoscopy (EGD) with esophageal biopsy from January 2016 till December 2018 were included.ResultsThere were 16 (7.7%) patients of refractory GERD diagnosed with EoE. There were more females than males (5:3). The median age was 58 years (range: 41-63 years). Dysphagia was the chief complaint leading to EGD followed by food impaction and heartburn. The median duration of symptoms was 46.5 months (range: 22-65 months). Erosive esophagitis, white plaques, and friability are common endoscopic findings; however, strictures are also not uncommon.ConclusionEosinophilic esophagitis is not uncommon in patients with refractory GERD. It may present with dysphagia, heartburn, and food impaction. Old patients with longstanding GERD, positive for atopy, not responding to gastric acid inhibitors must be considered for EoE screening via EGD and esophageal biopsy.

Prevalence of eosinophilic esophagitis in patients with gastroesophageal reflux symptoms: A cross-sectional study from a tertiary care hospital in North India.

Eosinophilic esophagitis (EoE) is being recognized increasingly all over the globe; Indian data is however sparse. We screened patients with symptoms of gastroesophageal reflux disease (GERD) for presence of EoE in them. Consecutive patients with symptoms suggestive of GERD underwent gastroduodenoscopy and esophageal biopsies, obtained from both the upper esophagus (5cm below the upper esophageal sphincter) and lower esophagus (5cm above gastroesophageal junction), as well as from any other endoscopically visible abnormal mucosa. Demographic and clinical characteristics, endoscopic findings, peripheral blood eosinophilic count, and history of use of proton-pump inhibitors (PPIs) were analyzed. Stool examination was done to rule out parasitoids. EoE was diagnosed if number of mucosal eosinophil infiltrate was >20 per high-power field. In the latter, Warthin-Starry stain was performed to rule out presence of H elicobacter pylori. Of 190 consecutive patients with symptoms of GERD screened, esophageal biopsies were available in 185 cases. Of them, 6 had EoE, suggesting a prevalence of 3.2% among patients with GERD. On univariate analysis, history of allergy, non-response to PPI, and absolute eosinophil counts and on multivariable analysis, history of allergy and no response to PPIs were significant predictors of EoE. Presence of EOE did not correlate with severity of reflux symptoms. In this hospital-based study from northern part of India, prevalence of EoE in patients with GERD was 3.2%. EoE should be considered as a diagnostic possibility, especially in those with history of allergy, no-response to PPI, and absolute eosinophil count of ≥250/cumm.

Eosinophilic Esophagitis and Esophageal Granular Cell Tumor: An Unexpected Association.

Esophageal granular cell tumors (GCTs) are rare. Eosinophilic esophagitis (EoE) is an immune-mediated disease characterized by esophageal eosinophilia despite proton pump inhibitor (PPI) therapy. Given that GCTs occur at sites of scarring and inflammation, we sought to determine the prevalence of EoE in patients with esophageal GCTs. Our center's pathology database was searched for GCT specimens from 1995 to 2014. Slides were blindly rereviewed. GCTs were scored for atypical cytological features. Presence and number of eosinophils in the tumor and the surrounding esophageal epithelium and any EoE features were recorded. Medical records were reviewed. From >30,000 esophageal cases, 23 esophageal GCTs were identified, with 18 available for review (16 adult, 2 pediatric). Median patient age was 38.7 years. Four adults had esophageal intraepithelial eosinophilia (peak 38 to 68 eosinophils/high power field [HPF]); 2 confirmed to have EoE, 1 with PPI-responsive esophageal eosinophilia, and 1 had not received PPI therapy. Both pediatric cases had confirmed EoE (peak 24 and 34 eosinophils/HPF). In total, 12/18 GCTs had intratumoral eosinophilia (peak 1 to 16 eosinophils/HPF). All 6 cases with esophageal eosinophilia had intratumoral eosinophilia. Two GCTs displayed atypical cytologic features. Esophageal eosinophilia was present in 25% of adult and 100% of pediatric GCTs, the majority confirmed to have EoE. Overall, 67% of cases had intratumoral eosinophilia and 2 had atypical features. On the basis of these findings, we propose evaluating surrounding tissue for eosinophilia when esophageal GCT is diagnosed, and adding GCT as a potential complication of untreated EoE. Research for an immunologic link between EoE and esophageal GCTs is needed.

The Prevalence of Eosinophilic Esophagitis in Pediatric Patients with IgE-Mediated Food Allergy

Eosinophilic esophagitis (EoE) is an allergic inflammatory disease that is triggered by food allergens and characterized by progressive esophageal dysfunction. Recently, EoE has been identified in patients who underwent oral immunotherapy (OIT) for IgE-mediated food allergy, suggesting an association. We sought to ascertain whether significant associations exist between IgE-mediated food allergies and EoE. Using the analysis of electronic medical record data and manual chart review, we examined our subspecialty care network of 35,528 children and adolescents to identify and characterize patients with IgE-mediated and EoE food allergy. The most common food allergens were defined, and the prevalence of EoE in patients with IgE-mediated food allergy was determined. Logistic regression was used to measure the extent to which IgE-mediated food allergy to specific foods is associated with EoE. The most common causes of EoE were milk, soy, egg, grains, and meats, an allergen pattern that is distinct from that of IgE-mediated food allergy. The prevalence of EoE in patients with IgE-mediated food allergy was higher than that reported in the general population (4.7% vs 0.04%). The distribution of IgE-mediated food allergens in patients with EoE was similar to that of the general population, and IgE-mediated allergy to egg (2.27; 1.91-2.64), milk (4.19; 3.52-4.97), or shellfish (1.55; 1.24-1.92) was significantly associated with an EoE diagnosis. Our findings support a clinical association between these conditions that has implications for the management of children with food allergy, and particular relevance to patients undergoing OIT.

Prevalence of Eosinophilic Esophagitis (EOE) in Hispanic Patients Presenting With Dysphagia and Food Impaction

Introduction: The prevalence of EOE in patients complaining of dysphagia and or food impaction is 10-15% in the Caucasian population1. The prevalence in Hispanics isn't well documented. The primary aim of this study was to define the prevalence of EoE in a predominantly Hispanic population presenting to a County Hospital with these complaints. Methods: This was a retrospective cohort study of adult patients presenting with dysphagia and/or food impaction having an EGD performed between August 2009 and September 2014. EoE was defined as >15 eosinophils/hpf on esophageal biopsy. Biopsies that met this criteria were reviewed and confirmed by a GI pathologist. Results: 311 patients underwent endoscopy for dysphagia and/or food impaction and 232 had 1 or more esophageal biopsies. 155 were Hispanic, 22 were Caucasian and 55 were “other”. The patients' age, gender and number of biopsies were noted. Eight patients with >15 eos/hpf were identified (3.4%) and were diagnosed with EOE. 5 of 155 Hispanic patients met this histologic criteria for EOE (3.2%) while 2/22 Caucasians (9.1%) and 1/55 “other” (1.8%) also met this criteria (Table 1). All patients with EOE (n=8) were male and less than 50 years of age. Endoscopic findings (rings, strictures, narrowing) were found in 4 of the 5 Hispanic patients (Table 2). Conclusion: The prevalence EOE in Hispanic patients in this study was considerable lower than that noted in the Caucasian patients in this study and is lower than that reported in Caucasian patients in the literature.1 - Hispanic patients in this study were male and younger than 50years of age. - Hispanic patients with EOE in this study frequently had visible endoscopic changes compatible with EOE. - Our study raises intriguing questions regarding the potential role for hygiene, diet, genetic and other factors that may have led to these findings.Figure 1Figure 2

Eosinophilic esophagitis: From pathophysiology to treatment.

Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. Traditionally considered a pediatric disease, the number of adult patients with EoE is continuously increasing, with a relatively higher incidence in western countries. Dysphagia and food impaction represent the main symptoms complained by patients, but gastroesophageal reflux-like symptoms may also be present. Esophageal biopsies are mandatory for the diagnosis of EoE, though clinical manifestations and proton pump inhibitors responsiveness must be taken into consideration. The higher prevalence of EoE in patients suffering from atopic diseases suggests a common background with allergy, however both the etiology and pathophysiology are not completely understood. Elimination diets are considered the first-line therapy in children, but this approach appears less effective in adults patients, who often require steroids; despite medical treatments, EoE is complicated in some cases by esophageal stricture and stenosis, that require additional endoscopic treatments. This review summarizes the evidence on EoE pathophysiology and illustrates the safety and efficacy of the most recent medical and endoscopic treatments.

Su1856 No Increased Risk of Celiac Disease in Subjects With Esophageal Eosinophilia or Eosinophilic Esophagitis. An Adult Population-Based Study

Objectives: Low-grade esophageal eosinophilia may be a manifestation of reflux disease but Eosinophilic Esophagitis (EoE) has previously been linked to Celiac disease (CD). However, population-based studies of the prevalence of EoE in patients with CD are lacking. Methods: A Population-based study of 1000 randomly selected adults in Northern Sweden. Study participants were invited to answer a questionnaire and undergo upper endoscopy. Three endoscopists performed all endoscopies during a 2.5-year period. Esophageal biopsies were obtained from 2 cm above, and at the Z-line. Any eosinophil infiltration of the epithelium was defined as esophageal eosinophilia and EoE was defined as having at least 15 eosinophils/ high power field (HPF, at magnification x40) in biopsies from the distal oesophagus. CD was defined on the basis of positive serology in parallel with mucosal abnormalities of the small intestine (increased number of intraepithelial lymphocytes and/or villous atrophy). We used Fisher's exact test to compare the prevalence of esophageal eosinophilia and EoE in patients with CD vs. controls who had also undergone upper endoscopy with biopsy. Results: Of the 1000 adults undergoing endoscopy, 48 (4.8%) had esophageal eosinophilia, 11 (1.1%) had EoE and 18 (1.8%) had CD. CD was diagnosed in 2/48 (4.2%) individuals with esophageal eosinophilia (controls: 16/952 (1.7%), p=0.21), but in none of the 11 individuals with EoE (controls: 18/989 (1.8%), p=1.0). Conclusion: This population-based study of 1000 individuals undergoing esophageal and duodenal biopsy found no increased risk of esophageal eosinophilia or EoE among individuals with CD.

High prevalence of eosinophilic esophagitis in patients with inherited connective tissue disorders

Eosinophilic esophagitis (EoE) is an emerging chronic inflammatory disease mediated by immune hypersensitization to multiple foods and strongly associated with atopy and esophageal remodeling. We provide clinical and molecular evidence indicating a high prevalence of EoE in patients with inherited connective tissue disorders (CTDs). We examined the rate of EoE among patients with CTDs and subsequently analyzed esophageal mRNA transcript profiles in patients with EoE with or without CTD features. We report a cohort of 42 patients with EoE with a CTD-like syndrome, representing 0.8% of patients with CTDs and 1.3% of patients with EoE within our hospital-wide electronic medical record database and our EoE research registry, respectively. An 8-fold risk of EoE in patients with CTDs (relative risk, 8.1; 95% confidence limit, 5.1-12.9; χ(2)1 = 112.0; P < 10(-3)) was present compared with the general population. Esophageal transcript profiling identified a distinct subset of genes, including COL8A2, in patients with EoE and CTDs. There is a remarkable association of EoE with CTDs and evidence for a differential expression of genes involved in connective tissue repair in this cohort. Thus, we propose stratification of patients with EoE and CTDs into a subset referred to as EoE-CTD.

Routine screening for eosinophilic esophagitis in patients presenting with dysphagia

Eosinophilic esophagitis (EoE) is a clinicopathologic disorder first described in 1978 which has gained significant recognition over the past 10 years. Numerous prevalence studies have been performed around the globe, both in pediatric and adult populations documenting a prevalence between 0.002% and 6.5%. The aim of this study is to assess the utility of routinely screening for EoE in patients with dysphagia. A prospective, observational study in which adult patients with a complaint of esophageal dysphagia were enrolled. Of the 135 patients enrolled, 122 completed the study; 100 patients had nonobstructive dysphagia, while 22 patients had a luminal finding which could explain their dysphagia. The prevalence of EoE in the nonobstructive dysphagia group was 22% (95% CI: 13.9-30.1%); 32.7% of male patients with nonobstructive dysphagia were found to have EoE compared with 8.9% of females (p = 0.004). The mean age of nonobstructive patients found to have EoE was 37.8 years. White patients with nonobstructive dysphagia were found to have a 25.9% prevalence of EoE, compared with 0% of African Americans, 0% of Asians, and 14.3% of Hispanics. When comparing Whites with non-Whites, the prevalence of EoE was noted to be 25.9% versus 5.3%, respectively (p = 0.050). EoE is a common cause of nonobstructive dysphagia. We believe that the high prevalence of EoE in patients with nonobstructive dysphagia supports the practice of routine biopsies to screen for the presence of abnormally high numbers of eosinophils in this subgroup.

S1872 Acid-Induced Injury Does Not Enhance Local Changes of Eosinophilic Esophagitis: An Analysis of 11 Histologic Findings

Introduction: Refractory GERD describes those patients who continue to have symptoms despite treatment with proton-pump inhibitors (PPI)1. The participation of eosinophilic esophagitis (EE) in the refractory GERD has been scarcely studied. When both disorders are simultaneously present, the clinical, endoscopic and histologic findings may be nonspecific and as such the overlap of refractory GERD and EE has been matter of debate. Aim: To study the occurrence of EE in patients with refractory GERD. Methods: Upper digestive endoscopies (UDE) were performed, obtaining mucosal biopsies of distal, middle and lower esophagus and stomach (body and antrum) in 97 adult consecutive patients. Erosive esophagitis was classified according to Los Angeles classification. Seventy three (75.3%) were female, with mean age of 44,4 (+ 9.09) of years. Eighty seven patients (89.6%) were submitted to esophageal manometry and pHmetry. The patients (82, 84%) have been receiving high doses of PPI (40 mg omeprazol b.i.d.) for at least 6 weeks. The main complaint was heartburn and regurgitation. The diagnosis of GERD was based on UDE and pHmetry. The diagnosis of EE was based on the presence of ≥20 eosinophils per high power field (eo/hpf) in the esophageal biopsies. Results: UDE was normal in 78 patients (81%). Erosive esophagitis (grade A in 9, B in 2 and C in 2 of LA) was found in 13 (13%) patients. All the others 6 (6%) were classified as non-erosive esophagitis (NERD). One patient ( 1 %) presented > 20 eo/hpf. In 25 (27.8%) patients the pHmetry was altered during PPI treatment (80 mg/day). The manometry showed hypomotility before the treatment for EE and, inespecific motor disturbances after the decreasing of eosinophils post the appropriate treatment. Conclusions: There was a very low prevalence of EE in patients with refractory GERD. (1) Spechler SNat Clin Pract Gastroenterol Hepatol, 2007

S1870 Low Prevalence of Eosinophilic Esophagitis in Patients with Refractory Gastroesophageal Reflux Disease. a Prospective Study

Introduction: Refractory GERD describes those patients who continue to have symptoms despite treatment with proton-pump inhibitors (PPI)1. The participation of eosinophilic esophagitis (EE) in the refractory GERD has been scarcely studied. When both disorders are simultaneously present, the clinical, endoscopic and histologic findings may be nonspecific and as such the overlap of refractory GERD and EE has been matter of debate. Aim: To study the occurrence of EE in patients with refractory GERD. Methods: Upper digestive endoscopies (UDE) were performed, obtaining mucosal biopsies of distal, middle and lower esophagus and stomach (body and antrum) in 97 adult consecutive patients. Erosive esophagitis was classified according to Los Angeles classification. Seventy three (75.3%) were female, with mean age of 44,4 (+ 9.09) of years. Eighty seven patients (89.6%) were submitted to esophageal manometry and pHmetry. The patients (82, 84%) have been receiving high doses of PPI (40 mg omeprazol b.i.d.) for at least 6 weeks. The main complaint was heartburn and regurgitation. The diagnosis of GERD was based on UDE and pHmetry. The diagnosis of EE was based on the presence of ≥20 eosinophils per high power field (eo/hpf) in the esophageal biopsies. Results: UDE was normal in 78 patients (81%). Erosive esophagitis (grade A in 9, B in 2 and C in 2 of LA) was found in 13 (13%) patients. All the others 6 (6%) were classified as non-erosive esophagitis (NERD). One patient ( 1 %) presented > 20 eo/hpf. In 25 (27.8%) patients the pHmetry was altered during PPI treatment (80 mg/day). The manometry showed hypomotility before the treatment for EE and, inespecific motor disturbances after the decreasing of eosinophils post the appropriate treatment. Conclusions: There was a very low prevalence of EE in patients with refractory GERD. (1) Spechler SNat Clin Pract Gastroenterol Hepatol, 2007

S1873 True/False: Eosinophilic Esophagitis (EoE) Responds to Acid Suppression

Introduction: Refractory GERD describes those patients who continue to have symptoms despite treatment with proton-pump inhibitors (PPI)1. The participation of eosinophilic esophagitis (EE) in the refractory GERD has been scarcely studied. When both disorders are simultaneously present, the clinical, endoscopic and histologic findings may be nonspecific and as such the overlap of refractory GERD and EE has been matter of debate. Aim: To study the occurrence of EE in patients with refractory GERD. Methods: Upper digestive endoscopies (UDE) were performed, obtaining mucosal biopsies of distal, middle and lower esophagus and stomach (body and antrum) in 97 adult consecutive patients. Erosive esophagitis was classified according to Los Angeles classification. Seventy three (75.3%) were female, with mean age of 44,4 (+ 9.09) of years. Eighty seven patients (89.6%) were submitted to esophageal manometry and pHmetry. The patients (82, 84%) have been receiving high doses of PPI (40 mg omeprazol b.i.d.) for at least 6 weeks. The main complaint was heartburn and regurgitation. The diagnosis of GERD was based on UDE and pHmetry. The diagnosis of EE was based on the presence of ≥20 eosinophils per high power field (eo/hpf) in the esophageal biopsies. Results: UDE was normal in 78 patients (81%). Erosive esophagitis (grade A in 9, B in 2 and C in 2 of LA) was found in 13 (13%) patients. All the others 6 (6%) were classified as non-erosive esophagitis (NERD). One patient ( 1 %) presented > 20 eo/hpf. In 25 (27.8%) patients the pHmetry was altered during PPI treatment (80 mg/day). The manometry showed hypomotility before the treatment for EE and, inespecific motor disturbances after the decreasing of eosinophils post the appropriate treatment. Conclusions: There was a very low prevalence of EE in patients with refractory GERD. (1) Spechler SNat Clin Pract Gastroenterol Hepatol, 2007

This Month in Gastroenterology

This Month in Gastroenterology

Prospective Analysis of Eosinophilic Esophagitis in Patients Presenting with Dysphagia

Purpose: Eosinophilic Esophagitis (EoE) is thought to be a rare inflammatory condition in adults, but the incidence may be rising. Recently it has become more prevalent in adults presenting with dysphagia. To date, there are no prospective studies looking at the prevalence of EoE in patients presenting with dysphagia. Methods: Patients presenting for EGD with a complaint of dysphagia at University Hospital (UH) and the VAMC were asked to participate. All patients completed a detailed questionnaire followed by EGD with four quadrant biopsies in the distal and proximal esophagus. EoE was defined as >20 eosinophils/hpf averaged over 5 random specimens in either the distal or proximal esophagus. Primary endpoint was the prevalence of EoE; secondary endpoints included age, gender, asthma, food allergies, and endoscopic findings. Fisher's exact and paired T-analysis were used for analysis. Results: (See Table) Ninety-six patients enrolled between December 2005 and May 2006 (56 VAMC, 40 UH). Two patients did not undergo esophageal biopsies and were excluded from the analysis (94 total patients). Median age was 59 years, and 68/94 (72%) were male. Eleven patients (11.7%) met pathologic criteria for EoE. No significant difference in EoE cases between male and female (p= 0.42). Mean age of EoE patients 38 ± 12 vs. 61 ± 15 for non-EoE patients (p < 0.0001). EoE was diagnosed in 19% of patients less than 50 years (RR 4.5 for age <50 vs. >50). Asthma was present in 5/11 (45%) of EoE cases vs. 19/83 of controls (23%) (p=.31). Food allergies present in 5/11 (45%) of EoE cases vs. 10/83 (12%) of controls (p < 0.05). Two EoE patients did not have the classic EGD findings (one esophagitis, one distal stricture). There was a ringed esophagus ± furrows in 6 patients whose biopsies did not meet histologic criteria.Table 1Conclusions: EoE was diagnosed in 11.7% of patients presenting with dysphagia with relative risk of 4.5 if age <50. Food allergies is a significant risk factor for EoE. Esophageal biopsies may be warranted in patients presenting with dysphagia especially in the younger population. Patients may not present with classic endoscopic findings.