Natural History of Eosinophilic Esophagitis as it Transitions from Childhood into Adulthood Reveals that Poor Prognosis is Associated with Food Allergy and Allergic Rhinitis
Published Online June 7, 2011
In an upcoming issue of The Journal of Allergy and Clinical Immunology (JACI), researchers from Cincinnati Children’s Hospital Medical Center examine the natural history of eosinophilic esophagitis (EoE) by questioning hundreds of patients previously diagnosed with esophageal eosinophilia before EoE was known to be a separate disease. Interestingly, only 27% were aware of their diagnosis, yet the majority continued to have chronic gastrointestinal symptoms an average of fifteen years after their endoscopy.
In their report, DeBrosse et al found that symptoms of food impaction and the need for esophageal dilation were more common in patients with esophageal eosinophilia than control patients with chronic non-specific esophagitis and healthy controls. Importantly, the presence of food allergy and allergic rhinitis were associated with an increased occurrence of dysphagia. The authors report for the first time that levels of esophageal eosinophil counts correlate with worse disease symptoms. Even though the current diagnosis of EoE is reserved for patients that have at least 15 eosinophils/high powered field (HPF), the authors found that chronic symptoms were associated with even lower levels of eosinophils (5 eosinophils/HPF).
In summary, this is an important set of findings as it suggests that disease morbidity is greater among patients with atopy. Taken one step further, these data support the need for allergy testing among patients with EoE, as identifying patients with atopy will not only assist in dietary management, but will help identify those at greatest risk for persistent disease. Indeed, this is a unique landmark study that defines the long-term natural history of EoE and the key role of allergy.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.