Published online: February 12, 2020
Non-esophageal eosinophilic gastrointestinal disorders (non-EoE EGIDs) represent a heterogeneous group of rare but increasingly described disorders of unknown etiology, defined by abnormal eosinophilic inflammation in the gastrointestinal tract not limited to the esophagus. Since their first description in 1937, few case reports, case series, and retrospective studies have been reported. Therefore, the exact epidemiology of non-EoE EGIDs remains still unknown.
In a recent article published in The Journal of Allergy & Clinical Immunology: In Practice, Licari and Votto performed the first systematic review and meta-analysis to estimate the incidence and prevalence rates of non-EoE EGIDs in adults and children referred to outpatient clinics for gastrointestinal symptoms. They used an extensive search strategy to retrieve all articles published since 1990, combining the terms of non-esophageal EGIDs and epidemiology from the major electronic bibliographic databases.
They found a total of 576 articles. The authors analyzed epidemiological and clinical data from 10 retrospective studies that met the inclusion criteria. Because none of the included articles were prospectively designed, they were unable to assess the incidence rate. The overall prevalence of non-EoE EGIDs among patients referred to clinics for gastrointestinal (GI) symptoms was 2%, thus higher compared to that reported in previously published studies. Furthermore, the prevalence of these disorders in symptomatic adults was also 1.9%. The limited number of available studies did not allow them to analyze the prevalence of non-EoE EGIDs in children. The prevalence of non-EoE EGIDs in developed countries was higher (2.4%) compared to that of developing countries (1.5%). The authors also analyzed the clinical features of patients with non-EoE EGIDs. Abdominal pain was the main gastrointestinal symptom in children (94%), while diarrhea was the most prevalent symptom (100%) in adults. Atopic comorbidities ranged from 25% to 54% of patients. Asthma, allergic rhinitis, and eczema were reported in 54% of patients and food allergy in 38%. Regarding therapies, authors reported that steroids were efficacious in all children and the response to first line-therapy (steroids, diet, montelukast, and ketotifen) was effective in 89% to 100% of all patients.
This study showed that non-EoE EGIDs seems to be prevalent disorders, with rising prevalence rates in recent years. Non-EoE EGIDs affect about 2% of patients referred to the hospitals for gastrointestinal symptoms, so physicians should recognize these disorders and consider their prevalent chronic nature, and the impact on patients’ quality of life.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.