Phenotypic Characterization of Eosinophilic Esophagitis in a Large Multicenter Patient Population from the Consortium for Food Allergy Research

J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1534-1544.e5. doi: 10.1016/j.jaip.2018.05.038. Epub 2018 Aug 1.

Abstract

Background: Eosinophilic esophagitis (EoE) is increasingly common, but data on phenotypic aspects are still incomplete.

Objectives: To describe the clinical, endoscopic, and histopathologic features of a large number of children and adults with EoE across the United States.

Methods: This was a multisite single visit registry enrolling subjects aged 6 months to 65 years with EoE. Participants provided responses regarding their medical history, with verification of the diagnosis and history by the study teams.

Results: A total of 705 subjects were analyzed (median [interquartile range] age at enrollment 11.2 [6.7-17.7] years, 68.2% male, 87.9% whites). Of these, 67 subjects had concurrent gastrointestinal eosinophilia, with gastric mucosa most common. An age- and race-dependent time gap was present between symptom onset and time of diagnosis (adults and whites with longer gap). Food allergy and atopic dermatitis were associated with a decrease in this gap. Symptoms varied with age (more dysphagia and food impaction in adults) and with race (more vomiting in non-whites). Esophageal rings and strictures at diagnosis were more common in adults, although esophageal eosinophilia was comparable among age groups. Concomitant allergic disease (91%), infectious/immunologic disorders (44%), neurodevelopmental disorders (30%), and failure to thrive (21%) were common. Depression/anxiety increased with age. EoE was reported in 3% of parents and 4.5% of siblings.

Conclusions: Gastrointestinal eosinophilia is present in approximately 10% of patients with EoE; the symptom-diagnosis time gap is influenced by age, race, food allergy, and atopic dermatitis; symptoms vary with race; concurrent infectious/immunologic disorders and mental health disorders are common; and the level of esophageal eosinophils is comparable in patients with and without fibrostenotic features.

Keywords: Atopy; Autoimmune disease; Eosinophilic colitis; Eosinophilic esophagitis; Eosinophilic gastritis; Eosinophilic gastroenteritis; Food allergy; Multisite; Proton pump inhibitor; Race; Registry.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biomedical Research
  • Child
  • Endoscopy
  • Eosinophilic Esophagitis / diagnosis*
  • Eosinophilic Esophagitis / epidemiology
  • Eosinophils / immunology*
  • Esophagus / pathology*
  • Female
  • Food Hypersensitivity / diagnosis*
  • Food Hypersensitivity / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Phenotype*
  • Population Groups*
  • United States / epidemiology
  • Young Adult