Gastroenterology

Gastroenterology

Volume 134, Issue 5, May 2008, Pages 1316-1321
Gastroenterology

Clinical–Alimentary Tract
Eosinophilic Esophagitis: A Prevalent Disease in the United States That Affects All Age Groups

https://doi.org/10.1053/j.gastro.2008.02.016Get rights and content

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.

Section snippets

Study Design and Database

This study identified patients diagnosed with EE using the Caris Diagnostics Database (based in Irving, TX). This database is derived from all patients referred to Caris Diagnostics, a provider of gastrointestinal pathology services for physicians from community-based freestanding endoscopy centers throughout the United States. Over the study period, the database contained 414,598 patient gastrointestinal pathology cases from 34 different states. This is a predominantly adult database, with

Results

During the study period, esophageal and/or gastroesophageal biopsy specimens were obtained from upper endoscopies in 74,162 unique patients. In this cohort of patients, roughly 98% were adults, and 2% were younger than 18 years. The cohort represented 217 different clients (≥1 physician at each client endoscopy center) in 34 different states for adult cases, and 74 clients in 23 states for pediatric cases. Over the 5-year study period, the age and sex were very similar year to year, with the

Discussion

This study examined a large population of patients with EE derived from a national database. There are several strengths of this study, most notable is that it is one of the largest series of patients with EE to date. Because cases were derived from samples submitted by community practices in 34 of the 50 states it is both geographically diverse and less prone to referral center bias. Cases were nested within the larger cohort of all patients who had undergone an upper endoscopy with biopsy

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Dr. Kapel is a consultant to Caris Diagnostics.

R.C.K. and J.K.M. are both first authors.

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