Eosinophilic Esophagitis Patients Are Not at Increased Risk of Severe COVID-19: A Report From a Global Registry

Abstract

What is already known about this topic? No data has been published on the outcome of coronavirus disease 2019 in eosinophilic esophagitis (EoE)/eosinophilic gastrointestinal disease (EGID) patients.What does this article add to our knowledge? COVID-19 severity in EoE patients appears to be comparable to that of the general population.How does this study impact current management guidelines? EoE/EGID patients with COVID-19 may be managed following guidelines for the general population.BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) on eosinophilic esophagitis (EoE) and eosinophilic gastrointestinal diseases (EGIDs) is unknown. OBJECTIVE: We aimed to characterize patients with EoE and EGIDs who had COVID-19, assess severity of COVID-19 in the EoE/EGID population, and evaluate for COVID-19-induced EoE/EGID flares. METHODS: We established an online global registry collecting physician entered, deidentified data related to patient demographics, EoE/EGID disease features, comorbidities, and treatments, COVID-19 source of exposure, symptoms, illness severity, hospitalizations, and deaths. RESULTS: Ninety-four cases were reported between March 2020 and April 2021 (median age, 21 years; range, 1.5-53 years; 73% male). Most had atopy (73%), and 80% had isolated EoE. Before COVID-19, the EoE/EGID activity was reported as clinical remission in 51 (54%) and moderate in 20 (21%). EoE/EGID treatments at the time of COVID-19 included proton pump inhibitors 49 (52%), swallowed/topical steroids 48 (51%), and dietary elimination 34 (36%). COVID-19 symptoms included cough (56%), fever (49%), anosmia (21%), and ageusia (22%). Most patients with COVID-19 had a mild course (70%), with 15% asymptomatic, 12% moderate, and 2% severe. Three patients were hospitalized, and no intensive care unit admissions or deaths were reported. Mean time from first symptoms to resolution in symptomatic patients was 10 days (range, 1-90 days). A single EGID flare was reported during COVID-19. CONCLUSIONS: In a global EoE/EGID registry, relatively few COVID-19 cases have been reported. COVID-19 severity was comparable to the general population. Based on this registry, it does not appear that patients with EoE are at increased risk for severe COVID-19 infection or that COVID-19 leads to EGID flares.

The impact of COVID‐19 on Japanese patients with eosinophilic gastrointestinal disorders during the vaccination era

“…No patient died. One patient had an EGID flare 17 . The authors concluded that patients with EGIDs may not have an increased risk of severe COVID‐19 and that COVID‐19 does not lead to EGID flares 17 …”

“…17 The authors concluded that patients with EGIDs may not have an increased risk of severe COVID-19 and that COVID-19 does not lead to EGID flares. 17 Although no clear associations between severe outcomes of COVID-19 and EGDIs were identified in the current study or in previous reports, this study has several strengths. First, the study period included the vaccination era.…”

Worsened Fibrostenotic Outcomes in Eosinophilic Esophagitis Patients Due to COVID-19-Related Endoscopy Cancellations

“…EoE is a chronic condition, and upper endoscopy is important for monitoring endoscopic and histologic response, and for performing esophageal dilations in patients with strictures or narrowing. The COVID-19 pandemic has not only had a direct impact on patients with EoE and on GI practice in general [ 14 – 20 , 23 ], but indirect impacts are likely though not yet extensively studied. The goal of our study, therefore, was to determine the impact of endoscopic procedure cancellations due to COVID-19 on outcomes in our EoE patient population.…”

“…Interestingly, patients with EGIDs have not been found to have an increased risk of COVID-19 infection or complications [ 20 – 25 ]. This may be due to patients with eosinophilic gastrointestinal disorders having reduced RNA levels of Angiotensin Converting Enzyme (ACE) type 2 and serine protease TMPRSS2, both important mediators for SARS-CoV-2 entry into host cells [ 20 , 23 ].…”

Recent advances in understanding the role of eosinophils

“…Whereas eosinophils may be associated with disease pathogenesis in COVID-19 infection, pre-existing eosinophilic conditions do not appear to be a risk factor for severe illness 60 , 61 . In fact, some studies have suggested that type 2 inflammation may exert a protective effect by limiting viral entry through modulation of angiotensin-converting enzyme 2 (ACE2) expression at respiratory and gastrointestinal (GI) epithelial surfaces 62 – 66 .…”