Eosinophilic Esophagitis: A Prevalent Disease in the United States That Affects All Age Groups

Robert C. Kapel, Jocelyne K. Miller, Carlos Torres, Saime Aksoy, Richard Lash, David A Katzka

Research output: Contribution to journalArticle

216 Citations (Scopus)

Abstract

Background & Aims: Most reports on eosinophilic esophagitis (EE) are limited to small series from single institutions. This study describes features of EE in a broader population. Methods: A national pathology database (Caris Diagnostics, Irving, TX) was used to identify EE cases from a cohort of upper endoscopies. Slides from potential cases were reviewed by pathologists. Study inclusion required a mean of (1) 20 eosinophils or more in 5 high-power fields, or (2) 30 eosinophils in 2-4 high-power fields. Endoscopists provided demographic and clinical information. Results: There were 363 cases identified from 74,162 patients and 26 states. EE had a male predominance (odds ratio, 3.0; 95% confidence interval, 2.4-3.8). Ages ranged from 1 to 98 years, including 42 children and 321 adults. The most common endoscopy indications in adults were dysphagia (70.1%) and gastroesophageal reflux disease (GERD)/heartburn (27.1%). Children most frequently reported GERD/heartburn (38.1%) and abdominal pain/dyspepsia (31.0%). A total of 25.1% of cases had a peak mucosal eosinophil count of 20-59, 29.2% had a peak mucosal eosinophil count of 60-100, and 45.7% had a peak mucosal eosinophil count of more than 100. There was no difference in the peak counts between age groups or sexes, but patients with dysphagia had higher counts (P < .001). The prevalence of EE increased during the study period (P < .001). Conclusions: EE is a national disease found in all age groups, more frequently in males. Dysphagia and GERD symptoms are common indications for endoscopy. The degree of eosinophilic infiltration is high throughout all ages and may be related to patients' symptoms. Our series highlights important elements of this disease, the prevalence and/or recognition of which is increasing.

Original languageEnglish (US)
Pages (from-to)1316-1321
Number of pages6
JournalGastroenterology
Volume134
Issue number5
DOIs
StatePublished - May 2008
Externally publishedYes

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Eosinophilic Esophagitis
Eosinophils
Age Groups
Deglutition Disorders
Gastroesophageal Reflux
Endoscopy
Heartburn
Dyspepsia
Abdominal Pain
Odds Ratio
Demography
Databases
Confidence Intervals
Pathology
Population

ASJC Scopus subject areas

  • Gastroenterology

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Eosinophilic Esophagitis : A Prevalent Disease in the United States That Affects All Age Groups. / Kapel, Robert C.; Miller, Jocelyne K.; Torres, Carlos; Aksoy, Saime; Lash, Richard; Katzka, David A.

In: Gastroenterology, Vol. 134, No. 5, 05.2008, p. 1316-1321.

Research output: Contribution to journalArticle

Kapel, Robert C. ; Miller, Jocelyne K. ; Torres, Carlos ; Aksoy, Saime ; Lash, Richard ; Katzka, David A. / Eosinophilic Esophagitis : A Prevalent Disease in the United States That Affects All Age Groups. In: Gastroenterology. 2008 ; Vol. 134, No. 5. pp. 1316-1321.
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abstract = "Background & Aims: Most reports on eosinophilic esophagitis (EE) are limited to small series from single institutions. This study describes features of EE in a broader population. Methods: A national pathology database (Caris Diagnostics, Irving, TX) was used to identify EE cases from a cohort of upper endoscopies. Slides from potential cases were reviewed by pathologists. Study inclusion required a mean of (1) 20 eosinophils or more in 5 high-power fields, or (2) 30 eosinophils in 2-4 high-power fields. Endoscopists provided demographic and clinical information. Results: There were 363 cases identified from 74,162 patients and 26 states. EE had a male predominance (odds ratio, 3.0; 95{\%} confidence interval, 2.4-3.8). Ages ranged from 1 to 98 years, including 42 children and 321 adults. The most common endoscopy indications in adults were dysphagia (70.1{\%}) and gastroesophageal reflux disease (GERD)/heartburn (27.1{\%}). Children most frequently reported GERD/heartburn (38.1{\%}) and abdominal pain/dyspepsia (31.0{\%}). A total of 25.1{\%} of cases had a peak mucosal eosinophil count of 20-59, 29.2{\%} had a peak mucosal eosinophil count of 60-100, and 45.7{\%} had a peak mucosal eosinophil count of more than 100. There was no difference in the peak counts between age groups or sexes, but patients with dysphagia had higher counts (P < .001). The prevalence of EE increased during the study period (P < .001). Conclusions: EE is a national disease found in all age groups, more frequently in males. Dysphagia and GERD symptoms are common indications for endoscopy. The degree of eosinophilic infiltration is high throughout all ages and may be related to patients' symptoms. Our series highlights important elements of this disease, the prevalence and/or recognition of which is increasing.",
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