Lack of seasonal variation in the incidence of eosinophilic oesophagitis in adolescent and adult non‐PPI‐responsive oesophageal eosinophilia midwestern US populations

Abstract

Background: Eosinophilic oesophagitis (EoO) has been associated with allergic disorders as well as aeroallergens. The current literature has shown a possible association between seasonal variation, mainly in the spring, and the incidence of EoO. However, this data was based on small population studies that did not exclude proton-pump inhibitor (PPI)-responsive oesophageal eosinophilia (PPI-ROE) in their cohort. Aim: The aim of this study was to determine if there is a seasonal variation associated with the diagnosis of EoO in patients that had been treated with high-dose PPI prior to diagnosis. Methods: Oesophageal biopsies were obtained from a cohort of patients who presented with symptoms of dysphagia, odynophagia, and heartburn during a 10-year period. Symptomatic patients who had biopsies from the mid and distal oesophagus with !20 eosinophils per high-power field (hpf) while on high-dose PPI treatment for at least 5 weeks were diagnosed as having EoO. The monthly and seasonal incidences were determined (winter, January-March; spring, AprilJune; summer, July-September; Autumn, October-December). Results: A total of 20,718 patients were identified and their records evaluated. From this cohort, 193 (0.93%) symptomatic patients had biopsy-proven oesophageal eosinophilia (!20 eosinophils/hpf) and no seasonal variation was seen in this group. However, only 57 (0.28%) had been adequately treated with PPI prior to diagnosis (i.e. non-PPI-ROE biopsy-proven EoO; !20 eosinophils/hpf: 39 males, 18 females; age 29.5 years). The most common medical history components included asthma (12.3%) and food allergies (3.5%), and the most common presenting symptoms included dysphagia (50.9%) and heartburn (26.3%). The monthly and seasonal incidences in our cohort were with no apparent trend (p ¼ 0.713 and 0.703, respectively). Conclusions: The incidence of EoO was consistent across all 12 months as well as during the four seasons. Our data does not support a seasonal variation in relation to the incidence of EoO in the US midwestern non-PPI-ROE population.

Seasonal distribution of initial diagnosis and clinical recrudescence of eosinophilic esophagitis: a systematic review and meta‐analysis

“…This observation supported the hypothesis of a relevant role for aeroallergens in the development and/or recrudescence of EoE in parallel to what happens with other atopic disorders frequently observed in these same patients. More recent research, however, failed to document such an association , with some authors documenting a higher incidence of EoE diagnosis during the fall . After collecting all the published data on this topic through a systematic search in multiple databases and subsequently analyzing the data with the aid of a random‐effects meta‐regression model of seasonal meta‐analyses, we were able to demonstrate no significant seasonal variations in the overall incidence of EoE and its flare ups.…”

“…Of the remaining 46 documents retrieved for complete evaluation, 28 were excluded for the following reasons: they lacked data for calculations (20), they contained repeated or duplicated information (6), they were editorials with no original data (1), or they dealt with esophageal eosinophilia but not EoE (1). In the end, 18 studies (comprising 14 full papers and 4 abstracts ) were included in the quantitative summaries of our systematic review (Fig. ).…”

Airborne and food sensitization patterns in children and adults with eosinophilic esophagitis

“…Its pathophysiology is yet unknown but emerging evidence indicates that airborne and food hypersensitivity may play a key role . Some reports show a seasonal variation of incidence of EoE, suggesting a role for airborne allergens in the clinical course of EoE, but the literature remains unclear on this point . Studies have shown that 68% of pediatric EoE patients have a history of allergic disorders such as allergic rhinitis (AR), asthma, atopic dermatitis, and food allergy (FA), and that allergy testing‐directed diets in children with EoE achieved 69% resolution of the symptoms .…”

Translating New Developments in Eosinophilic Esophagitis Pathogenesis into Clinical Practice

“…Recent human data suggest that aeroallergens might be more relevant in adults and older children documenting 89% of EoE adults having aeroallergen sensitization [24] and children aeroallergen sensitization increasing with age [25]. However, there are some conflicting epidemiological data disputing the seasonal trend in EoE incidence [26,27]. …”