Comparing Eosinophilic Esophagitis in a Black and Non-Black Pediatric Cohort

Abstract

Objectives: To compare presenting symptoms, comorbidities, disease, and treatment characteristics of a black pediatric eosinophilic esophagitis (EoE) group to a non-black pediatric EoE group. Methods: A retrospective chart review consisting of pediatric patients diagnosed with EoE between the years of 2010 and 2018 at a single urban pediatric hospital system comprising 143 black pediatric patients compared with 142 non-black pediatric patients with similar distribution of age and sex. Results: Both groups were majority male, and the median age of diagnosis between the black and non-black group was 5.1 and 6.7 years old, respectively. Comorbidities more commonly seen in the black group included food allergies, atopic dermatitis, asthma, and allergic rhinitis. Black patients were more likely to present with failure to thrive (FTT)/poor growth, whereas non-black patients were more likely to present with abdominal pain. There was no statistically significant difference between the groups in achieving remission using current therapies. The black group had higher rates of nonadherence to medical therapies. Conclusions: This is the largest study to date comparing a black versus non-black pediatric EoE population. The black population had more atopic comorbidities and FTT at presentation and had significantly more issues with nonadherence. This new knowledge describing EoE in a minority population will hopefully improve awareness, diagnosis, and management of EoE in this population.

Understanding the Sex, Racial, and Ethnic Disparities in Eosinophilic Esophagitis

“…31 There was no statistically significant difference between the groups in obtaining remission with available treatments, although the black group exhibited greater rates of no adherence to medical treatments. 30,31 Currently it is recognized that the incidence of EoE is increasing in the Western world and is less prevalent in Asia, despite both populations sharing similar endoscopic and clinical characteristics, and that there may be differences in clinical presentation amongst different ethnicities. 32 Sperry et al 28 found that whites with EoE were older than blacks, less likely to present with failure-tothrive, and more likely to have esophageal rings on upper endoscopy.…”

“…31 There was no statistically significant difference between the groups in obtaining remission with available treatments, although the black group exhibited greater rates of no adherence to medical treatments. 30,31…”

“…Black pediatric patients with EoE had higher rates of sickness and failure to thrive than non-black children. 31 There was no statistically significant difference between the groups in obtaining remission with available treatments, although the black group exhibited greater rates of no adherence to medical treatments. 30,31 Currently it is recognized that the incidence of EoE is increasing in the Western world and is less prevalent in Asia, despite both populations sharing similar endoscopic and clinical characteristics, and that there may be differences in clinical presentation amongst different ethnicities.…”

Dupilumab in adolescent eosinophilic esophagitis: Experience with fibrostenosis and eosinophilic gastrointestinal disease with esophageal involvement

“…A recent cross-sectional study demonstrated adherence of 76.2% in adolescents and 88.6% in younger children, 12 and a single center review found 33.6% nonadherence rates in a Black cohort versus 10.9% in the non-Black cohort. 13 Comorbid atopic disease may be an additional reason to consider dupilumab, although its cost may prevent it from being first-line therapies for diseases that can be well-controlled.…”

JPGN and the Year 2022

“…A retrospective chart review of pediatric patients diagnosed with EoE between 2010 and 2018 comprising 143 Black patients compared with 142 non-Black patients with similar distribution of age and sex was conducted (20). Both groups were majority male, and the median age of diagnosis in Black and non-Black group was 5.1 and 6.7 years old, respectively.…”