Detailed features of a large number of patients with eosinophilic esophagitis
Published online: August 1, 2018
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by esophageal symptoms and esophageal eosinophilic inflammation. EoE is an increasingly common disease, but data on its phenotypic characteristics are to date either lacking or incomplete.
Chehade and colleagues reported in The Journal of Allergy and Clinical Immunology: In Practice on the establishment of a multi-center single-visit registry of patients with documented EoE. Patients with a wide range of ages, racial backgrounds, geographical locations, and socioeconomic conditions were recruited from five US centers forming the Consortium of Food Allergy Research (CoFAR). Participants provided detailed responses regarding their demographics and their medical, surgical, and family history. In addition, the research team recorded data on their endoscopy and biopsy results.
Findings from this study included 1) gastrointestinal eosinophilic infiltration below the esophagus occurs in ~5% of patients; 2) a large time gap (1.5 years) between the onset of symptoms and the diagnosis of EoE exists, and this gap is influenced by age (adults had a longer time from symptom onset to diagnosis than children), race (whites had a longer time from symptom onset to diagnosis), and history of food allergy or allergic eczema (both associated with a decrease in the time gap); 3) symptoms vary with age (non-specific gastrointestinal symptoms such as stomachache and vomiting were more common in children, and esophageal symptoms such as heartburn, chest pain, and difficulty swallowing food were common in adults); 4) symptoms vary with race (difficulty swallowing food, esophageal food impactions, and heartburn were significantly more common in whites, while vomiting was significantly more common in non-whites); 5) failure to thrive was common (21.3% of patients), especially in the younger population; 6) infectious/immunological disorders including celiac disease were prevalent in patients with EoE (infections reported in 44.4%, autoimmune disease in 4.7% and celiac disease in 2% of patients) and their family members; 7) depression and anxiety had significant differences between age groups of patients with EoE and were observed to increase with age (for example, 24.0% in subjects ≥18 years of age compared to 9.3% in children <11 years of age); 8) there was a high prevalence of neurodevelopmental disorders including prematurity in the EoE population (29.6% of patients with history of neurological/developmental disorders); 9) esophageal eosinophils were comparable in number in patients with and without features of esophageal scarring (such as rings and narrowing), pointing towards the importance of concurrently treating the underlying esophageal inflammation when stretching of the esophagus is decided; and 10) family history of EoE and eosinophilic gastrointestinal disorders is present in a relatively large fraction of patients with EoE (6.2% and 4.8% with ≥1 parent and/or sibling respectively), which is consistent with a strong hereditary component to the disease
The authors concluded that educating physicians regarding the variability in symptoms is very important. They also pointed out that a multi-disciplinary approach is needed for better care of patients with EoE, given the concurrent medical problems that these patients have.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
Phenotypic Characterization of Eosinophilic Esophagitis in a Large Multi-Center
Patient Population from the Consortium for Food Allergy Research
Mirna Chehade, MD, MPH, Stacie M. Jones, MD, Robbie D. Pesek, MD, A. Wesley Burks, MD, Brian P. Vickery, MD, Robert A. Wood, MD, Donald Y.M. Leung, MD, PhD, Glenn T. Furuta, MD, David M. Fleischer, MD, Alice K. Henning, MS, Peter Dawson, PhD, Robert W. Lindblad, MD, Scott H. Sicherer, MD, J. Pablo Abonia, MD, Joseph D. Sherrill, PhD, Hugh A. Sampson, MD, Marc E. Rothenberg, MD, PhD