Epidemiology of Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) is an allergy-associated disease defined clinically by esophagus-related symptoms in combination with a dense esophageal eosinophilia, both of which are unresponsive to prolonged acid suppression with proton pump inhibitors. Over the last two decades EoE has increasingly been recognized in various geographical areas (mostly industrialized countries) with high socioeconomic development. The prevalence rate is increasing and reaches up to 50 patients per 100,000 inhabitants in some indicator regions. Whether this increased prevalence is due to a real increase in incidence, a result of increased awareness by health care providers or because of the nonfatal nature of EoE adding more and more cases to the patient pool is still a matter of controversy. Several studies have consistently demonstrated a male predominance in EoE, with a male-to-female risk ratio of 3:1. The average age at diagnosis ranges between 30 and 50 years and suggests that EoE is a disease of the middle-aged man. It can affect patients of every race, but the disease is more common among Caucasians. In both children and adults, EoE has been clearly associated with allergies to food and aeroallergens, and most EoE patients present with a personal allergic background (e.g. asthma, rhinoconjunctivitis or oral allergy syndrome). In conclusion, knowledge of epidemiologic parameters of EoE is crucial for identifying risk factors as well as pathogenic mechanisms, planning preventive measures and determining optimal treatment strategies.

The 2010–2015 Prevalence of Eosinophilic Esophagitis in the USA: A Population-Based Study

“…These features of EoE have been reported in the literature [1,24]. Previous studies have reported familial clustering of EoE, thereby pointing towards a genetic predisposition [4].…”

Eosinophilic oesophagitis in children can be effectively managed with elimination diets and corticosteroids

“…The pathogenesis and risk factors of the disease are not completely understood, but ingested and/or inhaled allergens have been implicated as contributing factors that trigger and maintain the eosinophilic inflammation of EoE in both children and adults [3,4]. Up to &90 % of children with EoE potentially have a food or environmental allergy [1,5].…”

“…EoE that is more commonly diagnosed in the spring/summer), but further studies are needed before the inflammatory activity of EoE can be linked to seasonal factors (e.g. pollen exposure and seasonal foods) [1,3]. Of note, a subset of EoE patients are not sensitized to food allergens, aeroallergens, or both [1].…”

“…The following are used to aid in the diagnosis of EoE [1,3,[5][6][7][8][9]: excluded In addition to GORD and PPI-REE, oesophageal eosinophilia is also a feature of diseases such as Barrett's oesophagus, Crohn's disease, drug-induced oesophagitis, and eosinophilic gastroenteritis affecting the oesophagus. Many of these differential diagnoses can be excluded through routine laboratory testing and a thorough review of the patient's clinical history.…”

“…During reintroduction, food triggers should be identified based on the recurrence of symptoms or oesophageal eosinophilia, and patients should be advised to eliminate these foods from their diets indefinitely [6,8]. Food elimination diets are highly successful in children [3].…”